UNIVERSAL
TREATMENT PLANNING 
ASAM 3rd Edition – Levels 1.0, 2.1, 2.5, 3.1, 3.5

PARTICIPATION OF OTHERS (ALL LEVELS)
Participation of others in this review period:

Client identifies the following professional supports involved in their care:
□ Primary care provider
□ Outpatient therapist
□ Psychiatrist / prescriber
□ Probation / parole officer
□ Case manager / social worker
□ Peer recovery specialist

Client identifies the following natural supports:
□ Partner / spouse
□ Parent / family member
□ Friend / sponsor / mentor
□ Faith / community leader

Options to document participation:
● Collateral contact with ___ (role) completed on (date) to coordinate care.
● Client was presented in clinical case consultation / multidisciplinary team meeting during this review period.
● No participation of others this period; client declined involvement of supports.
● No referrals completed during this period due to:
 □ No identified need
 □ Client preference
 □ Needs already met by existing providers
 □ Recent referral(s) in progress

TOXICOLOGY (ALL LEVELS)
● No toxicology screens completed during this review period.
● Toxicology screen completed on (date); results pending.
● Toxicology screen completed on (date); negative for all non-prescribed substances.
● Toxicology screen completed on (date); positive for (substance); addressed in treatment plan under Dimensions 1 and 5.

FAMILY / SUPPORT INVOLVEMENT (ALL LEVELS)
● Family / support involvement offered; client declined at this time.
● Client identifies supportive family member / support person willing to participate in a family session.
● Client reports strained or unsafe family relationships; involvement is clinically contraindicated.
● Client reports no current supports and is working on building a support network.
● Client has active legal restrictions (e.g., order for protection); family involvement limited or not appropriate.

DIMENSION 1 – ACUTE INTOXICATION & WITHDRAWAL POTENTIAL
Risk Rating (0–4): ___
Rationale:
(e.g., “Client reports last use 3 days ago, denies history of withdrawal seizures, mild tremors observed.”)

Example Problem Statements – 2.1 / 2.5 (Outpatient / Intensive Outpatient)
● Recent use of (substance) with risk for mild–moderate withdrawal.
● History of complicated withdrawal requiring monitoring.
● Initiating or adjusting MAT requiring monitoring.
● No current withdrawal symptoms; low risk (may defer).

Example Problem Statements – 3.1 / 3.5 (Residential)
● Recently admitted following detox; needs monitoring for PAWS.
● Current withdrawal symptoms requiring observation.
● Ongoing overdose/destabilization risk if leaving structured setting.

Example Goals
● Maintain stability and prevent medically dangerous withdrawal.
● Reduce withdrawal symptoms safely.
● Safely stabilize on MAT as prescribed.
● Increase awareness of early withdrawal symptoms.

Example Objectives
● Report withdrawal symptoms daily (residential) or each session (outpatient).
● Comply with withdrawal monitoring protocol for the first (X) days.
● Attend 1 medication management appointment by (date).
● Obtain naloxone and demonstrate overdose response knowledge by (date).

Example Strategies
● Staff will monitor using CIWA/COWS as indicated.
● Counselor will provide education on withdrawal and PAWS.
● Medical staff will adjust withdrawal medications as needed.
● Counselor will coordinate with MAT provider regarding stability.

DIMENSION 2 – BIOMEDICAL CONDITIONS & COMPLICATIONS
Risk Rating (0–4): ___
Rationale:
(e.g., “Client has uncontrolled diabetes and chronic pain affecting participation.”)

Example Problem Statements
● No significant biomedical concerns (may defer).
● Chronic medical conditions impacting functioning.
● Limited access to medical care or insurance barriers.
● Pain contributing to cravings or use.

Example Goals
● Improve management of biomedical conditions.
● Maintain regular medical care with PCP.
● Reduce impact of physical symptoms on mood and participation.
● Increase understanding of substance use effects on health.

Example Objectives
● Attend PCP/specialist appointment by (date).
● Report health changes within 24 hours (residential) or during sessions.
● Take prescribed medications and report adherence weekly.
● Identify 3 ways substance use impacts medical conditions by (date).

Example Strategies
● Counselor provides education on physical health and substance use.
● Staff assist with medical appointment coordination.
● Staff monitor health-related concerns and communicate with providers.
● Counselor integrates physical health into recovery planning.

DIMENSION 3 – EMOTIONAL, BEHAVIORAL, OR COGNITIVE CONDITIONS
Risk Rating (0–4): ___
Rationale:
(e.g., “Client reports PTSD symptoms and panic attacks increasing relapse risk.”)

Example Problem Statements
● Symptoms of depression, anxiety, PTSD, etc.
● Substance use as coping for emotional distress.
● History of self-harm, SI, or aggression requiring monitoring.
● Impulse control or emotional regulation difficulties.
● Needs coordination with mental health providers.

Example Goals
● Reduce mental health symptoms.
● Increase ability to regulate emotions without substances.
● Engage fully with mental health services.
● Improve insight into MH and substance use interaction.

Example Objectives
● Complete diagnostic assessment by (date).
● Attend all therapy/psychiatry appointments.
● Identify three coping strategies and use one weekly.
● Rate/report mood or anxiety weekly on a 0–10 scale.

Example Strategies
● Counselor provides CBT/DBT skills and grounding.
● Staff coordinate with MH providers (with ROI).
● Counselor incorporates safety planning when needed.
● Staff monitor mood, behavior, and cognition.

DIMENSION 4 – READINESS TO CHANGE
Risk Rating (0–4): ___
Rationale:
(e.g., “Client is ambivalent about abstinence but attends consistently.”)

Example Problem Statements
● Ambivalence about change.
● Motivation present but inconsistent follow-through.
● Participation due to external pressure.
● Difficulty identifying realistic recovery goals.

Example Goals
● Strengthen internal motivation.
● Support development of meaningful goals.
● Move client toward next stage of change.

Example Objectives
● Identify 3 personal reasons for change by (date).
● Complete pros/cons (decisional balance).
● Develop 3 measurable recovery goals within (X) weeks.
● Attend (X) hours of treatment weekly per LOC.

Example Strategies
● Counselor uses motivational interviewing.
● Staff provide education on addiction and change.
● Counselor reviews recovery goals regularly.
● Staff reinforce progress.

DIMENSION 5 – RELAPSE / CONTINUED USE POTENTIAL
Risk Rating (0–4): ___
Rationale:
(e.g., “Client has multiple prior relapses and high-risk environment.”)

Example Problem Statements
● Moderate–high relapse risk due to triggers or environment.
● History of multiple relapses.
● Limited relapse prevention planning.
● Limited coping skills for cravings or stress.

Example Goals
● Develop a relapse prevention plan.
● Improve management of triggers and cravings.
● Reduce exposure to high-risk situations.
● Strengthen sober supports.

Example Objectives
● Identify 5 triggers and 5 coping skills by (date).
● Complete written relapse prevention plan.
● Attend (X) recovery meetings weekly.
● Track cravings (0–10) for (number) weeks.

Example Strategies
● Counselor teaches relapse warning signs and coping tools.
● Staff process any lapse/relapse and reassess LOC.
● Staff provide community support resources.
● Counselor integrates relapse prevention into daily/aftercare planning.

DIMENSION 6 – RECOVERY ENVIRONMENT
Risk Rating (0–4): ___
Rationale:
(e.g., “Client lives in unstable housing with active use in home.”)

Example Problem Statements
● Limited or no sober supports.
● Unstable or unsafe living environment.
● Unemployment or lack of daily structure.
● Legal/CPS involvement.
● Strained family relationships impacting recovery.

Example Goals
● Enhance stability and safety of recovery environment.
● Increase involvement in sober activities.
● Address legal/CPS requirements.
● Strengthen communication and boundaries.

Example Objectives
● Meet with housing/case management resource within (X) days.
● Attend one sober activity weekly.
● Attend all legal/CPS appointments.
● Identify 3 trusted supports with contact information.
● Develop a weekly schedule that supports recovery.

Example Strategies
● Staff provide resources for housing, employment, education, and financial aid.
● Counselor provides education on boundaries and healthy relationships.
● Staff coordinate with CPS/legal/probation (with ROI).
● Counselor assists in building aftercare plan with community supports.