When it comes to determining how to place a person in addiction treatment, having a standard guideline based on the degree of substance abuse and the person’s motivation to change behaviors is valuable in providing the appropriate level of care.
As an example, a study from Addiction shows that providing a treatment setting that matches the severity of substance abuse is more likely to result in positive outcomes. For this reason, the American Society of Addiction Medicine (ASAM) has developed placement criteria that can help treatment professionals make this determination.
However, the criteria are only one part of the equation. Another part of the tool is a specific assessment process designed to assess the degree of substance abuse and readiness for change so that the criteria can be applied and the person can be matched to the care level most likely to provide positive progress for that person. Because determining a person’s needs can be challenging, the assessment developed by ASAM covers multiple dimensions, achieving the level of detail necessary to make an accurate placement determination.
The Six Dimensions of Assessment
The ASAM assessment process involves a process that takes into account biological, psychological, and social aspects of the individual’s ability to function to assess the severity of the substance abuse problem. The process is based on six parameters, called the six assessment dimensions.
According to information from the Association of Addiction Professionals, these dimensions include the following points:
- Acute Intoxication and/or Withdrawal Potential: This dimension determines whether or not the person is currently intoxicated or otherwise needs to detox and undergo withdrawal management. The degree of this dimension can determine placement in one of several care levels, depending on the need for medical intervention, supervision, and symptom management.
- Biomedical Conditions and Complications: This dimension assesses whether there are physical disorders or conditions that complicate the substance use disorder and must be considered during treatment, such as injury or disease that require medication or a doctor’s supervision.
- Emotional, Behavioral, or Cognitive Conditions and Complications: This dimension works to identify any co-occurring mental health disorders that may complicate the substance use disorder. These conditions require concurrent treatment, especially if their presence is likely to affect the treatment outcome.
- Readiness to Change: This assesses the person’s desire to enter treatment or the level of commitment to achieving recovery. If the person is determined to have a low readiness to change, motivational strategies may need to be employed at a low level of care to help the person develop commitment to treatment, at which point a step up to a higher level of care can be considered.
- Relapse, Continued Use, or Continued Problem Potential: This result can help determine whether the person is receiving education about the issues of addiction or is ready to develop tools and skills that prevent relapse. A person in the early stages of change may not be ready to apply the tools until an appropriate understanding of the reasons for abstaining from substance use is developed.
- Recovery Environment: The living situation, work or school life, relationship challenges, and other aspects of a person’s daily environment can affect the desire and ability to remain committed to treatment. If the person’s environment is considered to pose a risk to progress in treatment, a higher treatment level is likely to be recommended.
When this assessment is administered thoroughly and carefully, it results in a determination of the placement needs for the individual that match up with the appropriate level of care. For example, an individual with higher severity in the six dimensions can be placed in high-intensity inpatient care at ASAM Level III or Level IV, while a person with lower severity can enter outpatient care or partial hospitalization at Level I or Level II.
Research, including a study from the Journal of Addictive Diseases, shows that this assessment results in appropriate matches when the guidelines and criteria are followed thoroughly. Any inappropriate matches are usually the result of certain treatment levels not being available or improper practices of the assessors.
As explained in the Substance Abuse and Mental Health Services Administration’s Treatment Improvement Protocols, this is not just a one-time assessment. Throughout treatment, the individual’s progress is measured and any changes in assessment levels are taken into account to help the individual move through treatment.
For example, if an individual who completes residential treatment is assessed as having met certain goals and markers for growth in the assessment categories, that person can be moved down to a lower level of care based on the ability to maintain abstinence and manage symptoms. However, if those markers are not met, the person can be shifted to another type of care at the same level, or even stepped up to a higher level if the assessment indicates that this is necessary.
Through this continual treatment/assessment model, an individual in treatment for substance abuse or addiction can progress through care, with personalized treatment that can provide the care needed to achieve long-term recovery.