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ASAM

Most people understand that people with addictions need some form of help. These people did not choose to develop addictions. They do not want their lives to be full of misery and heartache. But it happened, and they need help in order to get better.

Most people understand this. But what kind of diagnosis would a person with an addiction get? Is a simple addiction diagnosis enough, or is there an underlying mental illness going on? And where should a person like this go for help? Is an outpatient treatment program the right choice, or should the person get care as a resident of a facility?

These questions might seem hard to answer. Thankfully, professionals who answer these questions do not have to do so alone. They can lean on the American Society of Addiction Medicine (ASAM) for help.

Understanding the Need

commonly abused drugs

When people enroll in treatment facilities and ask for help with an addiction, they might be using an instantly recognizable drug, like alcohol. But they might be using a different type of drug, too, and there are many different options available.

The National Institute on Drug Abuse lists 28 different commonly abused drugs, including:

  • Alcohol
  • Cocaine
  • Ayahuasca
  • Hallucinogens
  • Mescaline
  • Marijuana
  • Heroin
  • Cannabinoids
  • Cathinones
  • LSD
  • MDMA
  • DMT
  • Methamphetamine
  • Ketamine
  • Inhalants
  • Khat
  • Prescription painkillers
  • Prescription tranquilizers
  • Prescription stimulants
  • Psilocybin
  • Kratom
  • Over-the-counter drugs
  • PCP
  • Rohypnol
  • Salvia
  • Steroids
  • Tobacco

Some of these drugs cause serious withdrawal symptoms; others do not. When people appear and ask for help, clinicians will need to know which drugs require which response. Some people need medical detox, and others do not.

Similarly, many people who abuse drugs also have underlying mental illnesses. Mental Health America says that there are more than 200 different forms of mental illnesses — and mental health diagnoses — available for doctors to choose from. And each illness needs a slightly different form of treatment.

The symptoms of mental illness can also be incredibly vague. For adults, Mental Health America says that these are common signs of illness:

  • Confused thinking
  • Delusions
  • Hallucinations
  • Inability to cope with daily activities
  • Thoughts of suicide
  • Physical illnesses that can’t be addressed
  • Worries and anxieties
  • Withdrawal
  • Highs and lows
  • Depression
  • Changes in appetite or sleeping habits
  • Anger

Some of these symptoms can be caused by substance abuse. Others can be kept in check by substance abuse, and then burst to life when the substances have been removed from the body. Some people with these illnesses need inpatient care; others do not.

Finally, there are scores of people who are asked to diagnose both substance abuse and mental illness. Mental Health America says the issues can be diagnosed by:

  • Clinical and school psychologists
  • Clinical social workers
  • Licensed counselors
  • Certified substance abuse counselors
  • Nurse psychotherapists
  • Family therapists
  • Psychiatrists
  • Mental health nurse practitioners
  • Primary care physicians
  • Physician’s assistants
  • Nurse practitioners

Healthcare works best when it is delivered in the same way, no matter where the person who needs care might be living. That kind of coordinated care relies on a set of standards and rules that can be applied in the same way by anyone with access to the rules and regulations.

A key document published by the ASAM — the ASAM Criteria — is designed to help make that coordinated process come to life.

How the ASAM Clarifies Substance Abuse Treatment

professional assessment

The ASAM Criteria comes in two parts. The first is a set of rules that are designed to help clinicians assess the difficulties their clients face. There are six items these professionals should assess when people come to them for care.

  • 1. Withdrawal needs: Clinicians should understand the substances the person has been using and the doses of drugs the person takes regularly. Then, clinicians should determine whether or not that person is at risk for life-threatening withdrawal symptoms.
  • 2. Physical complications: A thorough health history, in which the clinician looks for physical health issues that could complicate recovery, is a key part of this assessment.
  • 3. Mental health issues: A person’s thoughts, feelings, and overall mental health status should be addressed at this stage.
  • 4. Readiness to change: Some people enroll in care because others ask them to do so; they do not see the need to change. Others enter care with a burning need to make life different. Still others fall somewhere in the middle of this spectrum. At this stage, clinicians should determine where their clients are in this process.
  • 5. Relapse or continued use: Some people with substance abuse issues cycle in and out of sobriety, relapsing every step of the way. Clinicians should address whether that’s a problem for the people they are trying to help.
  • 6. Environmental concerns: The place in which the person lives could have a big impact on recovery rates and times. Clinicians should gain an understanding of those issues.

The second stage involves determining what level of care is appropriate for the person in need. That continuum of care moves from the least-intense form of care to the most severe form of care.

By using these tools, clinicians can get a good understanding of the issues their clients face. And they can make good choices about where their clients should go in order to get the help they need to really heal.

Who Uses It?

ASAM states

In theory, anyone with a license to practice medicine and a client list that may include people who use drugs could use this document, but there are some states that take things a little further. ASAM says that 43 states require state-funded practitioners to use ASAM patient-placement criteria. The exceptions include:

  • Alabama
  • California
  • Indiana
  • Kentucky
  • Louisiana
  • Maine
  • Virginia
  • Vermont

 

Changes in Use

Information about addiction and recovery is always changing. Data that once seemed set in stone can change, and that often means recommendations about treatment changes, too.

It is no surprise then that the ASAM guidelines have changed many times. In fact, ASAM criteria have been revised three times, per a formal ASAM slide deck: in 1991, 1996, and 2001.

Early changes, per ASAM, dealt with new research and changing needs of practitioners. For example, when the original guidelines were developed, there were few facilities that were capable of providing help to people on a walk-in basis. Most clinics were set up to admit people as residents and to help them as they lived on the grounds. Much of that changed, and as a result, the guidelines were shifted to provide more guidance for ambulatory care.

In addition, the guidelines have been revised in the past to deal with new classifications of drugs and the new types of detoxification challenges they pose. Some newer drugs were just not mentioned in early

editions, but they did get mentions in later versions.

The latest version, released in October 2013, contains yet more changes. Per an analysis in ATTC Messenger, those changes involve considering addiction a chronic disease. Rather than assuming people with addictions will emerge healthy and whole from treatment, the guidelines emphasize helping people no matter where they are on the healing continuum, and understanding that people may slide from one intensity to another as the disease progresses.

For example, older editions may have assumed that people moved out of treatment altogether when their care programs were complete. The newest edition suggests that people may step down to the lowest form of care, but that they may need to come back for additional help as new challenges arise.

Understanding the Document

It can be a little disconcerting to read about how a document helps doctors to put people into specific treatment boxes. Most people want to be thought of as individuals, with individual needs and preferences. That is still true, no matter what the ASAM guidelines say. The clinician always has the right to make a personal decision based on the exams that professional performs, even if those decisions are at odds with the ASAM guidelines.

But these documents often have great benefit for people with addictions. With these guidelines, the people who provide addiction care can come just a little closer to understanding what life with an addiction is really like. As a result, they can provide the right kind of help and resources to people who have addictions, based on research done by experts all around the world. This document takes the guesswork out of providing the optimal level of care for people with addictions. That makes it very valuable indeed.

People with additional questions about the ASAM guidelines should make an appointment to talk with an addiction specialist. Asking how the professional uses the document, and finding out how that person thinks about the rules and regulations in those guidelines, could really help families to understand how addictions are both diagnosed and treated.

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