1 ___ Adequate ability to tolerate or cope with withdrawal discomfort. ___ Mild to moderate intoxication, or signs, symptoms interfere w/daily functioning, but not a danger to self or others ___ Minimal risk of severe withdrawal resolving and if alcohol, a CIWA-Ar score of 3-7 ___ Sub intoxication level.
“Severe signs/symptoms of intoxication indicates... an imminent danger to self or others”. Risk of severe but manageable withdrawal; or withdrawal is worsening.
ASAM Risk Rating Severity Matrix None / 0 Low / 1 Moderate / 2 High / 3 Severe / 4 Dimension 1 Mild to moderateFully functioning, no signs of intoxication or withdrawal present. ability to tolerate or cope with withdrawal Difficulty tolerating or coping with withdrawal Poor ability to tolerate or cope with withdrawal Incapacitated with
• The Columbia-Suicide Severity Rating Scale (C-SSRS) screener can be administered for all patients who have past or present risk factors for suicidality. – The C-SSRS full scale can be administered for patients who screen positive for current suicidality or self-harm.
SEVERITY RATING - DIMENSION 1 (Acute Intoxication and/or Withdrawal Potential) For guidance assessing risk, please see Risk Rating Matrices in The ASAM Criteria, 3rd ed.: • For alcohol, see pages 147-154 • For sedatives/hypnotics, see pages 155-161 • For opioids, see “Risk Assessment Matrix” on page 162
About the ASAM Criteria
The ASAM Criteria was built on a foundation of evidence around the multidimensional factors that influence disease severity and prognosis and expert consensus from a broad coalition of clinical stakeholders. See the methodology for the 4th Edition of the ASAM Criteria.
ASAM Criteria 4th Edition
The ASAM Criteria Fourth Edition is a comprehensive set of guidelines that use a holistic, person-centered approach to developing treatment plans for patients with addiction and co-occurring conditions.
Dimensions 4, 5 and 6 mild to moderate severity. Partial Hospital Program (Level 2.5): Dimensions 1, 2 and 3 warrant daily monitoring or management. Meet moderate severity in 2 out of 3 of Dimensions 4, 5 or 6. 6.
There are severe signs and symptoms of withdrawal, or risk of severe but manageable withdrawal; or withdrawal is worsening despite withdrawal management at a less intensive level of care (eg, as a continuation of withdrawal management at other levels of service, or in the presence of opioid withdrawal with cravings and impulsive behaviors).
The ASAM Criteria is a collection of objective guidelines that give clinicians a way to standardize treatment planning and where patients are placed in treatment, as well as how to provide continuing, integrated care and ongoing service planning. The criteria were developed by the American Society of Addiction Medicine (ASAM),
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