The 4th Edition of the ASAM Criteria is here!
Development has officially wrapped, the changes have been approved and the full release is slated for November 2023. The digital version of the 4th Edition of the ASAM Criteria is available now online and it’s currently possible to place an advanced order for the print version of the criteria, as well.
Written in collaboration with the Hazelden Betty Ford Center, the changes in the 4th edition represent ASAM’s growing commitment to patient-centered care, medication assisted treatment, harm reduction, and other evidence-based interventions for behavioral health. While the changes probably won’t act as immediate mandates for changes in the behavioral health world, it’s fair to say that the standards established in the ASAM Criteria have huge implications for any and all future developments in policies and laws that will, in turn, have a direct impact on the future of addiction treatment.
This post will go over some of the main changes that ASAM made to the criteria, as well as what the ramifications of those changes might be for recovery residences in particular.
What is the ASAM Criteria? And How Does Development of the Criteria Work?
The ASAM Criteria defines the standards for addiction treatment in the United States, particularly in states where an affiliate organization acts in a regulatory role. It’s created by the American Society of Addiction Medicine and published by Hazelden Publishing. The first edition was released in the 1980s. The latest edition - the 4th edition - was released in fall 2023.
ASAM is used by behavioral health professionals and payers to evaluate and standardize addiction treatment across all levels of care. Policymakers, like public health officials and those who legislate around public health matters, also rely on the ASAM criteria for unbiased information on how to understand the disease of addiction as well as how to manage it. The criteria are frequently cited in laws and regulations relating to the addiction treatment community.
Will Recovery Residences be Made a New, Official Level of Care by the Latest ASAM Edition?
The short answer to this question is: no, ASAM is not adding recovery housing as a new level of care.
Although the new ASAM edition did add several new levels of care to the existing system - like Level 1.0, Chronic Disease Management - recovery housing isn’t represented as an official level of care in the 4th Edition of the ASAM Criteria.
However, ASAM did go out of its way in the 4th edition to recognize the importance of recovery housing to long-term recovery. In a nod to this importance, the 4th edition outlines best practices for sober living homes at every level of care. To develop these standards, ASAM worked closely with the National Association of Recovery Residences, or NARR, which already upholds common sense standards for sober living homes through its state affiliate program.
These major changes come under the billing of “Access to Recovery Support Services,” which references the importance of creating “recovery-oriented systems of care” as well as “partnerships at each level of care” to encourage the “ongoing remission monitoring and recovery management checkups” that newly recovered patients need.
What Else Has Changed in the Newest ASAM Edition?
There have been many revisions to the 3rd edition of the ASAM criteria in the process of creating the 4th edition. They are:
Emphasis on harm reduction. The criteria actively encourages providers to consider the question of harm reduction and how to implement it in every patient’s journey. Part of this encouragement also features an emphasis on shared co-creation (rather than top-down administration) of treatment planning and management. When patients share the responsibility of their treatment with providers - or, better still, take complete ownership of their recovery journey - then they are able to build a better internal “locus of control” which, in turn, allows for a more empowered, lasting recovery. Part of building an internal “locus of control” in patients is creating room to meet all patients “where they’re at” rather than sorting patients into categories designed for provider convenience, like “treatment compliant” and “treatment resistant.” A harm reduction model embraces patients at all steps in their recovery journey and allows the patient to define their own behavioral health goals on their own terms.
Medication-positive treatment. The New ASAM Criteria removes any of the old reservations of medication assisted treatment and instead makes it easier to provide evidence-based care for patients in all facilities. Where old versions of the criteria were not explicitly anti-MAT, the newest criteria edition is explicitly pro-MAT.
Emphasis on recovery support services. The 4th edition pushes addiction treatment providers to build strong partnerships with recovery residences. The criteria affirms the importance of such a living arrangement, especially when it comes to monitoring for remission, screening for relapse potential, and gathering outcomes measurements.
Acceptance of the Chronic Care Model of treatment. The 4th edition showcases the importance of understanding the ongoing nature of addiction treatment. Recovery is not a “one and done” event as it is so often characterized in the media. Recovery is an ongoing process that continues throughout the lifetime of the patient. Addiction is a chronic disease. While “active addiction” may only be one phase of the addiction cycle, SUD patients are always at some risk of relapse and the truth is that most patients do experience episodes of relapse throughout their lifetime even with the best possible care. The 4th edition embraces this reality and provides for a new level of care - 1.0 - to describe the treatment that “fully recovered” patients still may require to maintain the remission of their disease.
Embracing co-occurring care. SUD often presents along with one or more other mental, physical, developmental or behavioral health conditions. In fact, “comorbid” or “co-occurring” patients are the norm, rather than the exception to the rule. The 4th edition of ASAM’s criteria acknowledges this fact and pushes to eliminate separate programs for dual diagnosis patients. Instead, ASAM pushes for dual diagnosis standards to be integrated into the fabric of all levels of care.
Integrating medical and behavioral healthcare into one continuum of care. It is common for medically managed detox and other biomedical services to be viewed as “medical” care on the one hand, while behavioral health services are viewed as a totally separate, often less “medical,” entity. It’s not uncommon for these programs to take place in different facilities with little or no coordination of care. The ASAM 4th edition moves to integrate the “bio” in “biopsychosocial” and pushes for better integration of all three areas of concern into each level of care in the continuum.
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