Description
Unformatted Attachment Preview
Kay complete an ASAM level of care placement & DSM Diagnosis
Kay never knew her biological father. When she was four years old her mother, married a man whom she called
“Daddy,” an alcoholic whom she thought for several years was her father. He was affectionate to her while her
mother was cold and critical; however, this affection soon took the form of sexual molestation. By the age of nine,
she realized “something was wrong here,” and she started trying to escape from him. For the next six years he was
“always trying to rape me.” When he was drunk and she resisted, he would physically abuse her as well, but not
her stepsister who was five years older and his biological daughter. Finally when she was 15, his alcoholism
became “so bad that he became abusive to my mother,” and her mother left him. Throughout this period some
extended family members were aware of the sexual abuse of Kay, but were afraid to bring it to her mother who
was in denial about it. Kay, who also felt it was useless to tell her mother, was left feeling unprotected, depressed,
and with “low self esteem.” She ran away to Florida but soon met a man who introduced her to marijuana and
cocaine. She began using socially just to stay awake so she could dance at the night club. Eventually she was
spending nights with customers for money and soon had a clientele of about twenty men per week. Each time she
engaged with a customer she would escape as she described as if she was in a dream and leave her body until the sex
act was over. She never used drugs while engaging with her customers. During the interview she reported that she
was tired, hungry, and had been smoking cocaine alone for three days before she ran out of money, she is depressed
since she sold her car for ten bags and has no way of getting to work.
Dimension 1 ___________________Dimension 2 ___________________
Dimension 3 _____________________
Dimension 4 ______________________
M.H. __________
Dimension 5 ______________________
M.H. ___________
Dimension 6 _____________________
M.H. _____________
Locus (QUADRANT) of CARE __________________
ASAM Level of Care _________________
DSM -5 Diagnosis _____________________________________________________________
DSM-5 Diagnosis ______________________________________________________________
Mental Health 224 in-class assignment
ASAM / LOCUS
Level of Care Utilization System/ American Society of Addiction Medicine
For the following case determine the proper ASAM.
(utilize or infer using your clinical judgement from the information provided below)
The client is a 38-year-old Hispanic/Latina woman who is the mother of two teenagers. Maria M.
presents with an 11-year history of crack cocaine dependence avg. $200 per week, and a 2-year
history of opioid dependence about $30 per day. She also has a history of trauma related to a
longstanding abusive relationship (now over for 6 years). She is not currently in an intimate
relationship at present and there is no current indication that she is at risk for either violence or
self-harm. Maria has a history of persistent major depression, and panic disorder being effectively
treated with antidepressants. She is motivated to stop using drugs. She supports her drug usage by
selling Marijuana, and also receives regular child-support from her wealthy ex- spouse, who
although abusive provides financial support for Maria and his two children. Maria currently smokes
cigarettes, about a pack every three days besides that she reports no major medical concerns.
Dim 1 ___________
Dim 2_____________
Dim 3_____________
DIM 4 S.A. ___________
DIM 4 M.H._____________
DIM 5. S.A._______________
DIM 5. M.H.______________
DIM 6. S.A._______________
DIM 6. M.H.______________
W/M _______
LEVEL OF CARE________________
Understanding and Using
Current ASAM Criteria
for Ce-Classes.com
Learning Objectives
After completing this course,
participants will:
Identify ASAM and the history of its
development
Describe how ASAM criteria fit into the
assessment process
Identify ASAM Levels of Care
Describe ASAM Dimensional Criteria
2
The 3rd Edition of the ASAM
Criteria
3
Overview of Training
What is ASAM and the history of its
development
How ASAM fits into the assessment process
Levels of Care
Dimensional Criteria
4
ASAM Criteria Background
In the late 1980’s a taskforce is
assembled to integrate existing admission
and continued stay criteria
Both NAATP and ASAM were involved
Ownership of the criteria was left with
ASAM
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5
ASAM Criteria Background
Goal –
unifying the addiction field to a
single set of criteria
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6
ASAM Criteria Background
The criteria were developed through a
collaborative process in which consensus
was achieved
Clinical experts, researchers and a
coalition of stakeholders were included in
the process
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7
ASAM Criteria Background
The edition with which most practitioners
are familiar is the Patient Placement
Criteria-2R (2001) which replaced the
1996 version
A new edition came out in the Fall of 2013
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8
ASAM Criteria Background
The ASAM criteria are guidelines for:
– Assessment
– Service planning
– Placement
– Continued stay
– Discharge
For clients with substance abuse
disorders
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9
ASAM Criteria Background
The ASAM criteria is a framework for
patient assessment that is
multidimensional
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10
ASAM Criteria Background
The ASAM criteria is also a description of
levels of care
– Levels of care refers to the places within
the service continuum from outpatient
to intensive inpatient treatment.
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ASAM Criteria Background
The ASAM criteria provides a means for
deciding upon the appropriate intensity of
service based upon the patient’s severity
of illness
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When to use ASAM
At first contact with client (at assessment,
when referral is made, to see if a referral is
appropriate for your program)
During treatment
– If not doing well
– If achieving goals
At discharge
– To see what the client needs next
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
13
How to Use the Criteria
To assign the appropriate level of
service and level of care.
To make decisions about continued
service or discharge by ongoing
assessment and review of progress.
To do effective treatment planning
and documentation.
14
ASAM Criteria
Basic Concepts
The main goal of the system is to provide
individualized – clinically driven –
treatment
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ASAM Criteria
Basic Concepts
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16
ASAM Criteria
Basic Concepts
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ASAM Criteria
Basic Concepts
Each element of the process informs
the next
This is a cyclical process
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ASAM Criteria Background
Intensity of Service is often referred
to as IS
Severity of Illness is often referred to
as SI
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19
ASAM’s New Definition of
Addiction
Addiction is a primary, chronic disease of
brain reward, motivation, memory and
related circuitry. Dysfunction in these
circuits leads to characteristic biological,
psychological, social and spiritual
manifestations. This is reflected in an
individual pathologically pursuing reward
and/or relief by substance use and other
behaviors.
ASAM (2011). Public Policy Statement: Definition of
Addiction
20
ASAM’s New Definition of
Addiction
Addiction is characterized by inability to
consistently abstain, impairment in
behavioral control, craving, diminished
recognition of significant problems with
one’s behaviors and interpersonal
relationships, and a dysfunctional
emotional response. Like other chronic
diseases, addiction often involves cycles of
relapse and remission. Without treatment
or engagement in recovery activities,
addiction is progressive and can result in
disability or premature death.
ASAM (2011). Public Policy Statement: Definition of
Addiction
21
Definition of Other Key Terms
Clinically managed: Directed by non
physician addiction specialist rather
than medical personnel. Appropriate
for individuals whose primary problems
involve emotional, behavioral,
cognitive, readiness to change, relapse
or recovery environment concerns.
Intoxication/withdrawal/biomedical
concerns are all minimal if they exist at
all.
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
22
Definition of Terms
Medically Monitored:
Services
provided by an interdisciplinary staff of
nurses, counselors, social workers,
addiction specialist and other health
and technical personnel under the
direction of a licensed physician.
Medical monitoring is provided through
appropriate mix of direct patient
contact, review of records, team
meetings, 24 hour coverage by a
physician and a quality assurance
program.
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
23
Definition of Terms
Medically Managed:
Services that
involve daily medical care, where
diagnostic and treatment services
are directly provided and/or
managed by an appropriately trained
and licensed physician.
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
24
Dimensional Assessment
ASAM Criteria should be utilized to:
– Determine the appropriate level of service and
level of care
– Conduct effective treatment planning and
documentation
– Make choices about continued service or
discharge through ongoing assessment and
review of progress notes
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
25
Dimensional Assessment
Dimension 1: Acute Intoxication/Withdrawal
Potential
Dimension 2: Biomedical Conditions and
Complications
Dimension 3: Emotional/Behavioral/Cognitive
Conditions and Complications
Dimension 4: Readiness to Change
Dimension 5: Relapse/Continued Use/Continued
Problem Potential
Dimension 6: Recovery Environment
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
26
ASAM Criteria
Assessment
Assessment of Biopsychosocial Severity
and Level of Function
This is the first step in the process
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Assessment of Severity &
Level of Function
First identify if there is acute intoxication
and/or withdrawal potential
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Assessment of Severity &
Level of Function
Evaluate
– Biomedical conditions & complications
– Behavioral conditions & complications
– Cognitive conditions & complications
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29
Assessment of Severity &
Level of Function
Evaluate
– Readiness to change
– Relapse/continued use potential
– Recovery environment
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30
What is ASAM PPC?
The Patient Placement Criteria
provide:
– A tool to use along with your clinical
judgment
– Criteria for how bad the problem is and
what the client needs
– A framework for determining who needs
what level of care
– Standard descriptions of levels of care
and who might need them
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
31
Client-Directed, Outcome
Informed
Enhances efficient use of limited resources
Variable length of stay determined by client need and
progress
Can increase retention and reduce drop outs and relapse
Broad flexible levels of care, such as mixing IOP and
housing to get a residential type program
Creative use of resources to develop a treatment package
for each client
Client and clinician have a choice about treatment levels –
least intensive while safe and effective
Can enter the system at any level of care and move as
needed
If there are limited levels of care in your area, link with
other providers as needed
32
The Heart of Client-Directed Tx
Build a therapeutic alliance… it is
the greatest determinant of
treatment outcome
33
The Heart of Client-Directed Tx
Come to agreement with your
client about the treatment
–Goals
–Strategies
–Methods
34
The Heart of Client-Directed Tx
If the client is not with you, your
treatment will not be effective
Help the client accomplish what
is important to them, which will
likely involve staying clean and
sober
35
The Heart of Client-Directed Tx
Court-ordered or leveraged
treatment can be effective
The goal may be to satisfy the
court order!
36
Assessment
What does the client want? Why now?
2. Multidimensional assessment including
strengths, supports, resources, risks and
deficits
3. Imminent danger
– Relates to all dimensions
– Immediate Need Profile
– Risks that require immediate attention
Consider the 3 H’s
– History
– Here and now
– How concerned are you
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
1.
37
The Three H’s of Assessment
History
Here and Now
How uncomfortable are you?
38
Rating Risk in the 6 Dimensions
0 – no or very low risk. Stable.
1 – mild discomfort, can be stabilized, functioning
restored easily
2 – moderate risk/difficulty functioning but can
understand support services
3 – serious difficulties – in or near imminent danger
4 – highest concern – severe, persistent, poor ability
to cope with illness, life threatening
Can also rate as LOW, MEDIUM, and
HIGH
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
39
How do the Dimensions lead
to a level of care?
Dimensions 1, 2 and 3 – high risk/severity =
immediate need for high intensity services
Dimensions 4, 5, and 6 – balance out
strengths and challenges in these dimensions
interact – combine and contrast to determine
the lowest intensity service level that is safe
and effective for the client (and others)
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
40
Dimension 1 – Acute
Intoxication/Withdrawal
What risk is associated with the
patient’s current level of acute
intoxication?
Are there current signs of
withdrawal?
Does the patient have supports to
assist in ambulatory detoxification, if
medically safe?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
41
Dimension 1 – Acute
Intoxication/Withdrawal
Is there significant risk of severe
withdrawal symptoms or seizures,
based on the patients previous
withdraw history, amount, frequency
chronicity and recent discontinuation
or significant reduction of alcohol or
other drug use.
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
42
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
0= no intoxication or
Does not affect
withdrawal or already
resolved
placement
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
43
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
1= minimum to
Level 1D – outpatient
moderate intoxication
or withdrawal with
minimal risk
(some onsite
monitoring)
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
44
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
2= has some difficulty
Level 2D – outpatient
coping with moderate
intoxication or
withdrawal, some risk
of more serious
symptoms
(extended onsite
monitoring)
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
45
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
3= has significant
Level 3.2D –
difficulty coping with
severe signs and
symptoms of
intoxication or
withdrawal, risk of
more severe
symptoms
residential (social
setting detox) or
Level 3.7D (social
setting detox with
medication support)
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
46
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
4= incapacitated with
Level 4D – inpatient
severe signs and
symptoms, continued
use poses clear
danger, withdrawal
poses clear danger
(hospital)
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
47
Dimension 2: Biomedical
Conditions & Complications
Are there current physical illnesses, other than
withdrawal, that need to be addressed because
they create risk or complicate treatment?
Are there chronic conditions that affect
treatment?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
48
Dimension 2: Biomedical
Conditions & Complications
Hypertension, cardiac disorders, vascular
disorders, diabetes, and seizure disorders are all
high on the list
Chronic benign pain syndromes are often an
issue
There are a range of chronic disorders that may
need to be considered in placement decisions
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
49
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
0: no biomedical
Does not affect
problems
placement
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
50
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
1= adequate ability to
Level 1
cope, mild to moderate
signs and symptoms
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
51
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
2= some difficulty coping,
Level 1, 2 or 3
problems may interfere
with treatment, fails to
care for serious
biomedical problems
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
52
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
3= poor ability to cope
Level 4
with serious biomedical
problems
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
53
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
4= incapacitated with
Level 4
severe biomedical
problems
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
54
Dimension 3: Emotional, Behavioral, or
Cognitive Conditions & Complications
Are there current psychiatric illnesses or
psychological, behavioral, emotional, or
cognitive problems that need to be
addressed because they create risk or
complicate treatment?
Are there chronic conditions that affect
treatment?
Do any emotional, behavioral, or
cognitive problems appear to be an
expected part of the addictive disorder,
or do they appear to be autonomous?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
55
Dimension 3: Emotional, Behavioral, or
Cognitive Conditions & Complications
Even if connected with the addictive
disorder, are they severe enough to
warrant specific mental health
treatment?
Is the individual capable of
managing the activities of daily
living?
Does the individual have the
resources to cope with the
emotional, behavioral, or cognitive
problems?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
56
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
0= no emotional or
Does not affect
mental health problem
or if it exists, it is
stable
placement
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
57
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
1= diagnosed mental
Level 1
disorder requiring
intervention but does not
interfere with treatment
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
58
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
2= persistent mental
Level 2
illness with symptoms
that interfere with
treatment but do not
constitute immanent risk
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
59
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
3= serious symptoms,
Level 3
disability, and impulsivity
but not requiring
involuntary hospitalization
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
60
Matching assessment of
severity with level of care
Assessment of Severity
Level of Care
4= serious symptoms,
Level 4
disability and impulsivity
requiring involuntary
hospitalization.
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
61
Dimension 4- Readiness /
Motivation
What is the individual’s emotional
and cognitive awareness of the need
to change?
What is his or her level of
commitment to and readiness for
change?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
62
Dimension 4- Readiness /
Motivation
What is or has been his or her
degree of cooperation with
treatment?
What is his or her awareness of the
relationship of alcohol or other drug
use to negative consequences?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
63
Dimension 4: Readiness to Change
Pre-contemplation:
does not
know they have a problem. “In
denial.” Avoids thinking about
their behavior. Risk rating: 4
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
64
Dimension 4: Readiness to Change
Contemplation:
aware of
problem but ambivalent. Teeter
between cost and benefit of
continued use. Risk rating: 3
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
65
Dimension 4: Readiness to Change
Preparation:
intending to take
action in the immediate future
Risk rating: 2
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
66
Dimension 4: Readiness to Change
Action:
specific overt changes
have been made in the last 6
months to reduce risk. Risk
rating: 1
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
67
Dimension 4: Readiness to Change
Maintenance:
achieved change
goals for 6+ months. Risk
rating: 0
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
68
Matching assessment of severity with
level of care
Not as direct a correlation between
Dimensions 4, 5, and 6 and levels of
care
May need to use motivational
strategies to attract them into
treatment
Resistance is expected and does not
exclude clients from treatment
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
69
Matching assessment of severity with
level of care
If risk is low in other dimensions,
may work on increasing motivation
in a lower level of care first to
prepare for treatment: a “discovery
plan”
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
70
Matching assessment of severity with
level of care
If high risk/severity in other
dimensions, may need to “contain”
the client and do motivational
enhancement in a higher level of
care
Look for strengths
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
71
Dimension 5: Relapse, Continued Use
or Continued Problem Potential
Is the patient in immediate danger of
continued severe mental health
distress and or alcohol and drug use?
How aware is the patient of relapse
triggers, ways to cope with cravings
to use, and skills to control impulses
to uses or impulses to harm self or
others?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
72
Dimension 5: Relapse, Continued Use
or Continued Problem Potential
Does the patient have any
recognition of, understanding of, or
skills with which to cope with his or
her addictive or mental disorder in
order to prevent relapse, continued
use or continued problems such as
suicidal behavior?
Lee, Editor (2001) ASAM PPC-2R, ASAM Patient Placement Criteria
for the Treatment of Substance Related Disorders, 2nd Ed Revised,
73
Dimension 5: Relapse, Continued
Use or Continued Problem Potential
Relapse:
stops using on purpose
and begins again
Continued use:
never stops using
to begin with
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
74
Dimension 5: Relapse, Continued
Use or Continued Problem Potential
Would continued use/relapse be
dangerous to the client or to others
– Children
– Other adults in their lives
– Others in the world
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
75
Dimension 5: Relapse, Continued
Use or Continued Problem Potential
How severe are the problems if the
individual is not successfully engaged
in treatment at this time?
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
76
Dimension 5: Relapse, Continued
Use or Continued Problem Potential
How aware is the individual of relapse
triggers:
– Ways to cope with cravings to use,
– Skills to control impulses to use or,
– Impulses to harm self or others?
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
77
Matching assessment of severity with
level of care
Have to consider in relation to other
dimensions
High severity can indicate need for higher
intensity of services but not necessarily
Consider the lowest intensity that is safe
and effective
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
78
Dimension 6: Recovery/Living
Environment
Assess for risks, issues, strengths, skills, and
resources in:
– Recovery supports
– Living environment
– Family, friends, social network
– Work/school
– Finances
– Transportation
– Legal mandates/requirements
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
79
Matching assessment of severity
with level of care
Consider in relation to other dimensions
High severity can indicate need for higher
intensity of services but not necessarily
Consider the lowest intensity that is safe and
effective
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
80
Continued Treatment
Guidelines
Keep the client in the current level of
care if:
– They are making progress but have not yet achieved
their goals
– They are not yet making progress but have the
capacity to resolve their problems, are actively
working on goals, and continued treatment is
necessary to reach their goals
– New problems have been identified that can be
treated at this level
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
81
Discharge & Transfer Criteria
Consider transferring if:
– They have achieved their goals and
resolved the problem (transfer to a
lower level of care)
– They are unable to resolve the
problem despite adjustments to the
treatment plan (increase level of care)
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
82
Discharge & Transfer Criteria
Consider transferring if:
– They demonstrate a lack of capacity to
resolve the problems (increase level of
care)
– If their problems get worse or
– If more problems emerge that can’t be
effectively treated at this level of care
(increase level of care)
Posze, L . ASAM PPC-2R Patient Placement Criteria 101
83
Discharge Planning
Discharge planning is part of treatment
planning
It isn’t a separate or isolated activity
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
84
Discharge Planning
A discharge plan is really a deferred
treatment plan
It should be as specific and concrete as
any other treatment plan
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
85
Levels of Service
Each level of care has specific
parameters which define it
86
Outpatient with Supportive Living
Provides structure and support
Primary medical services not
necessary
Patients not in “Imminent Danger”
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Residential Treatment
Provides 24 hour:
– Structure and support (except 3.1 24
hours)
Primary medical services not
necessary
Patients in “Imminent Danger”
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Inpatient Treatment
Provides 24 hour:
– Structure and support
– Access to medical & nursing services
Patients in “Imminent Danger”
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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What is Imminent Danger?
A strong probability that certain behaviors
will occur (e.g., continued alcohol or drug
use or non-compliance with psychiatric
medications)
These behaviors will present a significant
risk of serious adverse consequences to
the individual and/or others (as in a
consistent pattern of driving while
intoxicated)
The likelihood that such adverse events
will occur in the very near future
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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What is Imminent Danger?
In order to constitute “Imminent
Danger” ALL THREE ELEMENTS
must be present
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Imminent Danger
Requires In-patient treatment
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need
A criteria to be considered in
determining level of care
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Immediate Need Profile
Dimension #1: Acute
Intoxication/Withdrawal Potential:
(a) Have you ever had life-threatening
withdrawal signs or symptoms?
___ No ___Yes
(b) If yes, are you currently having similar
withdrawal symptoms?
___No ___Yes
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need Profile
Dimension #2: Biomedical Conditions and
Complications:
(a) Do you have any current, untreated severe
physical problems?
___No ___Yes
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need Profile
Dimension #3: Emotional/Behavioral
Conditions & Complications:
(a) Do you feel that you are imminently in
danger and could harm yourself or
someone else?
___No ___Yes
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need Profile
Yes to Dimension 1, 2, and/or 3
Questions:
Requires that the caller/client immediately
receive medial or psychiatric care
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need Profile
Dimension #4: Treatment
Acceptance/Resistance:
(a) Do you feel that you are in immediate need
of alcohol/drug treatment?
__No __Yes
(b) Have you been referred or required to have
an assessment and/or enter treatment by the
criminal justice system, health or social services,
work/school, or family/significant other?
__No __Yes
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need Profile
Yes to Dimension 4 Alone:
Client to be seen for an assessment as
soon as possible – must be within 48
hours,
Client assessed for motivational
strategies, unless client imminently likely
to walk out and needs containment
strategies
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need Profile
Dimension #5: Relapse/Continued
Use Potential
(a)Are you currently under the influence?
__No __Yes
(b) Are you likely to continue use of
alcohol and/or other drugs, or to relapse,
in an imminently dangerous manner?
__No __Yes
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the Criteria.
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Immediate Need Profile
Yes to Dimension 5, Question (a):
Requires the client receive assessment for
withdrawal potential
Shulman & Associates. (2007). American Society of Addiction
Medicine (ASAM) How and When to Use the C
