ASAM Criteria 4th Edition Implementation

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The ASAM Criteria 4th edition was published in December 2023, and California’s Department of Health Care Services (DHCS) will be transitioning California’s Drug Medi-Cal system of care into alignment with ASAM Criteria 4th edition standards. The current system of care is aligned with the ASAM Criteria 3rd Edition (published in 2013).

In preparation for this transition, SAPC provider agencies should take steps now to prepare their staff by reviewing the ASAM Criteria 4th edition implementation tools that include training resources, a downloadable training slide deck, and additional reference materials. SAPC will be updating our treatment network guidance to align with the ASAM Criteria 4th Edition, and related trainings are posted on our SAPC Trainings and Events page.

ASAM Criteria 4th Edition Implementation Site

Overview of the Updates to the ASAM Criteria 4th Edition

Updated Assessment Standards
- Level of Care Determined through Dimensional Drivers
Updated ASAM Criteria Levels of Care
- Universal Access to Addiction Medications (aka Medications for Addiction Treatment)
- All levels of care should be co-occurring capable
- Withdrawal management integrated as a service component into the continuum of care; withdrawal management levels of care eliminated
- A 3.3 level of care (LOC) from the ASAM Criteria 3rd Edition eliminated; a slower pace of treatment is a patient-centered consideration in ever level of care
- Outpatient LOC is now labeled 1.5
- New 1.0 level of care: Long-Term Remission Monitoring
- New Recovery Residence level of care
Forthcoming ASAM Criteria Tools and Resources from ASAM
- New Paper-Based Assessment (anticipated early 2025)
- Updated Computer-Based Assessment (anticipated early 2025)
- Adolescent and Transition Age Youth (anticipated early 2026)
- Correctional Settings and Reentry (anticipated 2027)
- Behavioral Addictions (i.e., gambling, internet and gaming addiction, sex addiction) (anticipated 2028)

ASAM Criteria 4th Edition Assessment Dimensions and Subdimensions for Adults

Fourth Edition

Intoxication, Withdrawl, and Addition Medications

Biomedical Conditions

Psychiatric and Cognitive Conditions

Substance Use-Related Risks

Recovery Environments Interactions

NEWPerson-Centered Considerations

Dimension 1 - Intoxication, Withdrawal, and Addiction Medications

Intoxication and associated risks
Withdrawal and associated risks
Addiction medication needs

Dimension 2 - Biomedical Conditions

Physical health concerns
Pregnancy-related concerns
Sleep problems

Dimension 3 - Psychiatric and Cognitive Conditions

Active psychiatric concerns
Persistent Disability
Cognitive Functioning
Trauma exposure and related needs
Psychiatric and cognitive history

Dimension 4 - Substance Use Related Risks

Likelihood of risky substance use
Likelihood of risky SUD-related behaviors

Dimension 5 - Recovery Environment Interactions

Ability to function in current environment
Safety in current environment
Support in current environment
Cultural perceptions of substance use

Dimension 6 - Person-Centered Considerations

Patient preferences
Barriers to care
Need for motivational enhancement

ASAM Criteria 4th Edition Continuum of Care for Adults

Level 4:
Inpatient

4Medically Managed Inpatient

Level 3:
Residential

3.1Clinically Managed Low-Intensity Residential

3.5Clinically Managed High-Intensity Residential

3.7Medically Managed Residential

Level 2:
IOP/HIOP

2.1Intensive Outpatient (IOP)

2.5High-Intensity Outpatient (HIOP)

2.7Medically Managed Intensive Outpatient

Level 1:
Outpatient

1.0Long-Term Remission Monitoring

1.5Outpatient Therapy

1.7Medically Managed Outpatient

Recovery
Residence

RRRecovery Residence