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ASAM Standards of Care: What Is Involved in a Comprehensive Initial Assessment?


The American Society of Addiction Medicine’s (ASAM’s) Standards of Care Manual is the handbook for addiction medicine specialists across the United States. In it, ASAM outlines the standards for the behavior and treatment that governs addiction medicine.

This article, the first in a series of articles about ASAM standards of care, discusses the components of a comprehensive initial assessment of a new patient in your addiction medicine practice.

Addiction Medicine Initial Assessment Rules

“Understanding the extent and nature of a woman’s substance use disorder and its interaction with other life areas is essential for careful diagnosis, appropriate case management, and successful treatment.”
Treatment Improvement Protocols

When developing patient treatment modalities, the addiction medicine specialist must also stay current on laws and regulations governing substance abusers while also closely following patient privacy and confidentiality rules. These regulations must be followed carefully from the first interaction between provider and patient to outpatient treatment.

It is recommended that providers leverage standardized screening protocols such as the Drug Abuse Screening Test (DAST) or CAGE for alcohol abuse.

Addiction medicine

Screening and assessment are different parts of addiction medicine treatment.

It is important to note that screening for the problem is not the same as the assessment protocols outlined under ASAM’s guidelines. Screening helps addiction medicine specialists determine if there is a problem; assessment helps determine how deep the problem goes and helps a provider develop an individualized treatment plan.

Screening should encompass:

  • Whether co-morbidities may be a factor.
  • Whether there are immediate risks related to withdrawal or intoxication.
  • The risk of self-harm or violence.
  • Other mitigating factors such as PTSD or anxiety disorders.

Once screening determines the problem, a more thorough assessment can occur.

ASAM acknowledges that “assessment of a patient with a substance use disorder is an ongoing process.” Brief assessments can occur during urgent care, while a more thorough assessment can be conducted over time.

The more comprehensive assessment should include:

  • A careful physical and mental status exam.
  • A patient history.
  • The patient’s substance use history.
  • Documentation of addictive or reward-seeking behaviors that led or contributed to the use disorder.
  • Treatment history (if any) for the substance use disorder.
  • Treatment history (if any) for mental health disorders.
  • A detailed family history including documentation of any physical or mental disorders along with substance use.
  • Current allergies.
  • Current prescriptions.
  • The patient’s social history.
  • Understanding the patient’s current ability to seek treatment or desire to pursue their addiction and any circumstances that will impede or hinder them.
  • Understanding barriers to treatment.

The addiction medicine specialist must then use this assessment to determine a diagnostic formulation and treatment plan.

Benefits of ASAM Guidelines in Addiction Medicine

The ASAM guidelines have become the most widely used treatment protocols in addiction medicine today. The guidelines are the gold standard in the field and are helpful to both providers and patients in assessing and managing effective treatments for substance use disorders. The ASAM guidelines extend beyond assessment to guide addiction medicine professionals through goal setting, risk assessment, and the determination of the treatment intensity and length.

ASAM is, in fact, the single source of truth for addiction medicine providers in the United States. Check back in for upcoming articles with more information about the ASAM standards of care for addiction medicine practitioners.

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