ASAM CRITERIA – SIMPLE QUICK SUMMARY
(Adult Severity, Risk 0–4, and Matching Service Intensity)

Use this as a quick reference when assigning risk ratings and justifying level of care.

DIMENSION 1 – ACUTE INTOXICATION / WITHDRAWAL

0 – No current risk
• No signs of intoxication or withdrawal; or symptoms are fully resolved.
• Stable on MAT with no withdrawal.
• Services: No withdrawal management needed beyond routine monitoring.

1 – Mild risk
• Mild–moderate intoxication or withdrawal that does not pose imminent danger.
• Can cope with symptoms; low risk of severe withdrawal.
• Services: Low-intensity monitoring/withdrawal management; possible MAT dose adjustment and counseling.

2 – Moderate risk
• Noticeable difficulty managing withdrawal; symptoms may be significant but not life-threatening.
• Moderate risk of complicated withdrawal (e.g., heavy alcohol/sedative use with some risk).
• Services: Moderate-intensity monitoring or withdrawal management; coordination with MH/medical providers as needed.

3 – Severe risk
• Poor ability to tolerate withdrawal; severe intoxication or withdrawal with possible danger to self/others.
• Symptoms not improving at lower level of care.
• Services: High-structure, nurse/medical-monitored withdrawal management; frequent checks and close observation.

4 – Extreme / life-threatening risk
• Incapacitated, very severe withdrawal (e.g., seizures, delirium), or continued use is life-threatening.
• Services: 24-hour, medically managed withdrawal (hospital/medically managed level of care).

DIMENSION 2 – BIOMEDICAL CONDITIONS / COMPLICATIONS

0 – No current risk
• No significant medical problems or stable, well-managed conditions.
• Services: Routine medical care only.

1 – Mild risk
• Mild–moderate physical symptoms (e.g., pain) that interfere somewhat with functioning.
• Services: Low-intensity medical support and case management to coordinate care.

2 – Moderate risk
• Medical issues that interfere with recovery and may be neglected (e.g., poorly managed chronic conditions, signs of malnutrition).
• Services: Moderate-intensity medical care and monitoring; active coordination with SUD/MH treatment.

3 – Severe but stable risk
• Serious, ongoing health problems (e.g., severe pain, brittle diabetes) that are stable but require close oversight.
• Services: Higher-intensity medical and nursing monitoring to maintain stability and support treatment.

4 – Critical / unstable risk
• Severe, unstable medical problems (e.g., uncontrolled diabetes, GI bleed, severe infection).
• Services: 24-hour, medically focused care for stabilization and medication management (hospital/medically managed).

DIMENSION 3 – EMOTIONAL, BEHAVIORAL, OR COGNITIVE CONDITIONS

0 – No or stable MH symptoms
• No significant MH concerns or well-managed, stable disorder with good coping and impulse control.
• Services: No additional MH services beyond routine care.

1 – Mild risk
• Diagnosed or subclinical MH symptoms that need support but don’t significantly disrupt SUD treatment.
• Services: Low-intensity MH services (medication monitoring, psychoeducation, support groups, basic case management).

2 – Moderate risk
• Chronic or recurring MH symptoms that significantly interfere with recovery but are not imminently dangerous.
• Some suicidal ideation/violent impulses may be present but manageable with monitoring.
• Services: Moderate-intensity MH services, structured monitoring, medication management, and coordinated SUD/MH care.

3 – Severe risk
• Severe symptomatology and disability, high impulsivity, frequent decompensation, but not requiring locked/involuntary care.
• Services: High-intensity MH services with close monitoring; integrated or “psychiatrically enhanced” SUD treatment; intensive case management.

4 – Imminent danger
• Severe MH symptoms with immediate risk to self/others or inability to care for self (e.g., active suicidality, dangerous psychosis).
• Services: 24-hour, secure, medically and psychiatrically managed setting; SUD services integrated into MH care.

DIMENSION 4 – READINESS TO CHANGE

0 – Fully ready and engaged
• Actively engaged, committed to change, and taking responsibility.
• Services: Standard treatment; no special engagement strategies needed.

1 – Mild ambivalence
• Willing to be in treatment, recognizes some problems, but is ambivalent or underestimates needed change.
• Services: Low-intensity motivational work (education, supportive counseling, family/legal reinforcement).

2 – Low readiness / passive participation
• Reluctant, inconsistently involved, low follow-through with therapy, meds, or supports.
• Services: Moderate-intensity engagement (motivational strategies, clear limits and consequences, possible court/externally mandated structure).

3 – Minimal awareness / resistance
• Little insight into problems, inconsistent or resistant follow-through with recommendations.
• Services: High-intensity motivational enhancement, use of leverage (family, legal, employer), assertive case management/ACT where indicated.

4a – No awareness, not dangerous
• No insight into SUD/MH illness; blames others, rejects treatment, but not currently dangerous or unable to care for self.
• Services: Very high-intensity engagement and outreach, strong systems leverage, ACT preferred over “confrontation.”

4b – No follow-through with imminent danger
• Refusal or inability to engage leads to imminent harm to self/others or inability to care for self.
• Services: Secure placement, possible involuntary care, close monitoring until stable.

DIMENSION 5 – RELAPSE / CONTINUED USE / CONTINUED PROBLEM POTENTIAL

0 – Very low risk
• Low relapse potential with strong coping skills and supports.
• Services: Routine supports / self-help as desired.

1 – Mild risk
• Some vulnerability, fair coping and relapse prevention skills.
• Services: Low-intensity relapse prevention (skill reinforcement, medication management if needed, linkage to continuing care/self-help).

2 – Moderate risk
• Limited understanding of relapse issues; can manage only with prompts/support.
• Services: Moderate-intensity relapse prevention, structured skills training, close monitoring, assertive linkage to supports; possible ACT/case management.

3 – High risk
• Poor awareness of relapse patterns and weak coping skills; repeated problems.
• Services: High-intensity relapse prevention, structured coping skills work, strong use of family/ systems leverage, assertive case management/ACT, and possibly higher level of care.

4a – Chronic, severe risk (not currently dangerous)
• Multiple treatment episodes, ongoing relapse, minimal improvement; unable to manage illness but not imminently dangerous.
• Services: Very high-intensity relapse prevention, long-term structured support, assertive outreach, supportive living, ACT plus coordinated SUD/MH treatment.

4b – Imminent danger from continued use/relapse
• Ongoing use or MH decompensation places self/others in immediate danger.
• Services: Secure setting for stabilization, close observation, intensive medical/psychiatric management, then step-down with strong supports.

DIMENSION 6 – RECOVERY / LIVING ENVIRONMENT

0 – Supportive or manageable environment
• Environment supports recovery or patient can cope with mild stressors.
• Services: No special housing or environmental services needed.

1 – Mildly unsupportive but manageable
• Passive or indifferent supports; some strain but patient can cope.
• Services: Help with practical supports (transportation, child care, vocational/skills training) as needed.

2 – Non-supportive, needs structure
• Environment is not recovery-friendly; patient can manage only with clinical structure.
• Services: Assistance finding more supportive living, skills/vocational training, and possibly assertive case management/ACT depending on other dimensions.

3 – Hostile/stressful, difficult to cope even with structure
• Environment is clearly detrimental; patient struggles to cope despite treatment structure.
• Services: Assertive help securing a safer/more supportive setting, intensive support services, outreach, and ACT.

4a – Chronically toxic environment
• Long-term, hostile, or toxic setting (e.g., constant use around them, chronic instability) and patient cannot cope.
• Services: Highly assertive efforts to change living situation, possibly residential care (e.g., Level 3.1+), plus case management and ACT.

4b – Acutely dangerous environment
• Home setting is actively unsafe or abusive, posing immediate danger (e.g., living with dealer or violent partner).
• Services: Immediate separation and placement in a safe setting (shelter, residential, protective housing), then appropriate level of care based on all dimensions.