# The ASAM Criteria: Dimensions & Levels of Care Explained > The ASAM Criteria for treatment providers: the six dimensions, the levels of care, what changed in the Fourth Edition, and where to get the official materials. # The ASAM Criteria: Dimensions, Levels of Care, and What Changed in the Fourth Edition The six dimensions, the levels of care, what changed in the Fourth Edition, and where the official assessment materials actually come from. ![The ASAM Criteria: Six Dimensions and Levels of Care](/assets/blog/feat-asam.webp) **The ASAM Criteria** is the set of standards published by the American Society of Addiction Medicine for deciding what intensity of addiction treatment a person needs. Clinicians assess six dimensions, then match the person to a level of care on a continuum. The current version is the [Fourth Edition](https://www.asam.org/asam-criteria). Here is the problem with almost every ASAM chart circulating online right now. The Fourth Edition changed the continuum. Level 0.5 and Level 3.3 are gone. Withdrawal management is no longer a parallel track. Level 2.5 is not called partial hospitalization anymore. If your intake packet, your payer templates, or your website still use those labels, they describe a continuum that no longer exists. This guide is a working overview of the criteria and levels of care as they stand now: the current six dimensions, the current continuum, an old-to-new crosswalk, who is actually allowed to conduct the assessment, and where the real materials come from. ## What Is the ASAM Criteria? ASAM stands for the American Society of Addiction Medicine. The ASAM Criteria is its set of guidelines for matching a person with a substance use disorder to the right intensity of service, and for deciding when to continue, step up, step down, or discharge. It is widely used across US addiction treatment, in clinical practice and in payer utilization review. The intent is to standardize how placement decisions get made without flattening individual needs. That is the methodology in one sentence, and it is why any published standard of this kind exists: to improve the quality and consistency of decisions made across very different programs. It is worth being precise about what it is not. It is not a diagnosis. The DSM-5 tells you whether a substance use disorder is present and how severe it is. The ASAM Criteria tells you what level of service that person needs. Two different questions, two different tools, used together. A clinician can diagnose a severe alcohol use disorder and still place the person in outpatient care, because severity of diagnosis and intensity of service are not the same variable. It is also not a payer policy, even though payers lean on it heavily. More on that below. The Fourth Edition is being released in four volumes. [ASAM lists](https://www.asam.org/asam-criteria) Volume 1 (Adults) and Volume 2 (Adolescents and Transition-Aged Youth) as available, Volume 3 (Correctional Settings and Reentry) as anticipated in 2028, and Volume 4 (Behavioral Addictions) with no date yet. According to [ASAM's own FAQ](https://www.asam.org/asam-criteria/criteria-faq), the adult volume was released digitally in October 2023, with print following in December 2023. That timeline matters. Anything written about the ASAM Criteria before late 2023 describes the Third Edition, and a lot of what was written after it still does. ## The Six ASAM Dimensions The point of a multidimensional assessment is to stop placement from being driven by one variable. Without it, level of care tends to get decided by substance type, by how many prior treatment episodes someone has had, or by what bed happens to be open. The six dimensions force a wider read of the person in front of you. | Dimension | What it looks at | Legacy name still on most cheat sheets | | --- | --- | --- | | **1. Intoxication, Withdrawal, and Addiction Medications** | Current intoxication, withdrawal risk, and the role of addiction medications in the person's care | Acute Intoxication and/or Withdrawal Potential | | **2. Biomedical Conditions** | Physical health problems that affect treatment, including pregnancy, pain, and chronic disease | Biomedical Conditions and Complications | | **3. Psychiatric and Cognitive Conditions** | Co-occurring mental health and cognitive conditions that shape what treatment can realistically be delivered | Emotional, Behavioral, or Cognitive Conditions and Complications | | **4. Substance Use-Related Risks** | Risks arising from continued use, including overdose risk and harm to self or others | Readiness to Change and Relapse, Continued Use, or Continued Problem Potential | | **5. Recovery Environment Interactions** | How housing, family, work, transport, and community either support or undermine recovery | Recovery/Living Environment | | **6. Person-Centered Considerations** | The person's own goals, preferences, and circumstances, used to shape the final recommendation | No direct Third Edition equivalent | Current dimension names are from [ASAM](https://www.asam.org/asam-criteria). The legacy column shows the Third Edition terminology still used by most published charts, listed so you can recognize what you are holding. Treat it as an orientation aid rather than an exact mapping: the Fourth Edition reorders and redefines the dimensions, so this is not a one-for-one rename. Two orientation points before you use it. Dimension 3 is where cognitive impairment and co-occurring conditions get weighed, which matters because the framework is built for addiction and co-occurring conditions together rather than for substance use in isolation. Dimension 6 is where the person's own goals and circumstances enter the recommendation. One change deserves its own line, because it is functional rather than cosmetic. In the Fourth Edition, [Dimension 4 no longer contributes independently](https://www.asam.org/asam-criteria/asam-criteria-4th-edition) to the level of care recommendation. It informs clinical judgments about risk in the other dimensions instead. If your internal scoring logic treats all six dimensions as equal inputs to a placement decision, that logic is out of date. For the dimension-by-dimension breakdown and how risk ratings work in practice, see our full guide to [the six ASAM dimensions](/asam-dimensions/). ## ASAM Levels of Care in the Fourth Edition Start with the numbering logic, because most people misread it. ASAM describes the continuum as [four broad treatment levels, 1 through 4](https://www.asam.org/asam-criteria/asam-criteria-4th-edition), with decimal gradations of intensity inside each level. So 3.1, 3.5, and 3.7 are three intensities of residential care, not three unrelated programs. Level 1.0 Long-Term Remission Monitoring is new in the Fourth Edition, and the previously separate medically managed levels were folded into the main continuum. | Level | Name | What it looks like in practice | | --- | --- | --- | | **1.0** | Long-Term Remission Monitoring | Low-touch ongoing monitoring for people in sustained remission. New in the Fourth Edition. | | **1.5** | Outpatient Therapy | Standard outpatient counseling, scheduled sessions, person lives at home. | | **1.7** | Medically Managed Outpatient Treatment | Outpatient care with physician-led medical management, including outpatient withdrawal management. | | **2.1** | Intensive Outpatient Treatment | IOP. Multiple structured sessions per week while living at home. | | **2.5** | High-Intensity Outpatient Treatment | More programming hours per week than IOP, still without residential stay. This is what the Third Edition called partial hospitalization. | | **2.7** | Medically Managed Intensive Outpatient Treatment | High-intensity outpatient programming with daily medical oversight. | | **3.1** | Clinically Managed Low-Intensity Residential Treatment | 24-hour supportive living with structured clinical services at lower intensity. | | **3.5** | Clinically Managed Medium to High Intensity Residential Treatment | 24-hour residential treatment with substantial clinical programming. Absorbs the former Level 3.2-WM. | | **3.7** | Medically Managed Residential Treatment | Residential care under physician-led medical management, including residential withdrawal management. | | **4** | Medically Managed Inpatient Treatment | Acute inpatient care in a hospital-level setting. | Level numbers and names above follow the Fourth Edition transition guidance published by the [Illinois Department of Human Services](https://www.dhs.state.il.us/page.aspx?item=170097). State summaries occasionally gloss the names slightly differently, so check your own state agency's published guidance before you put these labels on a license application or a payer packet. The "in practice" column is our plain-language description of setting and intensity, not ASAM's service characteristics or staffing standards. Read the table as a scale of service intensity rather than as a menu. Outpatient services sit at 1.5 and 2.1, more intensive services at 2.5 and 2.7, residential at 3.1 through 3.7, and Level 4 is acute inpatient care. The same intensity of services logic drives continued stay and step-down decisions, not just the first placement. You reassess, compare what the person needs now against their current level of care, and move them. Two quick answers people search for constantly. **IOP is Level 2.1.** **Residential runs 3.1 through 3.7**, increasing in medical intensity as the decimal rises. ![The ASAM levels of care, from outpatient to residential](/assets/blog/c-asam-1.webp) The ASAM levels of care, from outpatient to residential ## What Changed From the Third Edition to the Fourth This is the table nobody publishes in one place, which is odd, because most of the sector is living through the transition right now. | Third Edition | Fourth Edition | What changed | | --- | --- | --- | | Level 0.5 Early Intervention | No longer a level of care | Removed. Renamed Early Intervention and Secondary Prevention and reframed as a broad response to addiction rather than part of specialty treatment. | | Level 1 Outpatient | Level 1.5 Outpatient Therapy | Renumbered. Function is consistent with the previous level. | | Level 1-WM | Level 1.7 | Withdrawal management folded into the main continuum. | | Level 2-WM | Level 2.5 | Withdrawal management folded into the main continuum. | | Level 2.5 Partial Hospitalization | Level 2.5 High-Intensity Outpatient Treatment | Same number, new name. "PHP" is legacy terminology. | | Level 3.2-WM | Integrated into Level 3.5 | No longer a standalone level. | | Level 3.3 | No longer exists | Eliminated. | | Level 3.7-WM | Level 3.7 Medically Managed Residential Treatment | Clarified as residential care. | | No equivalent | Level 1.0 Long-Term Remission Monitoring | New level. | Sources: [Illinois DHS](https://www.dhs.state.il.us/page.aspx?item=170097) for the level changes, [ASAM's Criteria FAQ](https://www.asam.org/asam-criteria/criteria-faq) for the withdrawal management mapping, and [ASAM](https://www.asam.org/asam-criteria/asam-criteria-4th-edition) for Level 1.0. The Level 0.5 change deserves a note of its own. Reframing early intervention as secondary prevention rather than specialty treatment puts prevention and treatment on one continuum for people with substance use risk, instead of treating them as separate silos. The withdrawal management change is the one that catches programs out. Detox did not disappear. The service still exists at every intensity it existed at before. What moved is the number that authorizes it, which means every internal form, payer template, and service description built around the old parallel WM track needs rewriting. One nuance on editions. ASAM's FAQ advised continuing to use the Third Edition criteria for adolescents while later volumes were still pending, and Volume 2 for adolescents and transition-aged youth is now listed as available. Treat that as transition history rather than a current instruction, and confirm with your state agency which edition governs your license today. ## Who Is Qualified to Conduct an ASAM Assessment? The honest answer is that ASAM does not say. [ASAM states](https://www.asam.org/asam-criteria/criteria-faq) that it does not specify the requirements of who can complete the Level of Care Assessment. It says assessors should operate within the scope of practice defined by state or other local authority, and it generally recommends that assessments are completed by clinical staff. That is not a dodge. It is a jurisdictional reality. The binding requirement comes from your state licensing board, your state Medicaid program, and your payer contracts, not from ASAM. Pennsylvania is a useful example of how that plays out. Under the state's [ASAM alignment guidance](https://www.pa.gov/content/dam/copapwp-pagov/en/ddap/documents/professionals/documents/asam-page/asam-update/asam-alignment-faq.pdf), clinical supervisors must be licensed by the Pennsylvania Department of State or fully certified as an addictions counselor. Notice what is being regulated there: the supervisor, not the interviewer. Several states take that approach, which is why "who can do the assessment" and "whose signature has to be on it" are two separate questions. If you operate in more than one state, document the requirement per site rather than writing one internal policy and assuming it travels. Record the supervision and countersignature rules alongside the assessor credentials. That single document saves a great deal of argument during a utilization review or a licensure inspection. It also belongs in your [licensing documentation set](/rehab-center-licensing-requirements/) from the start. ## Where to Get the Real Assessment Materials Start with the good news, because it is genuinely underpublicized: ASAM publishes free assessment guides for the Fourth Edition. The [Level of Care Assessment guide](https://www.asam.org/asam-criteria/implementation-tools/Criteria-assessment-guides) is available now. ASAM describes it as "a streamlined tool that helps clinical interviewers collect just enough information to make an appropriate level of care recommendation," and says it is "free and available for use by treatment providers." It is designed for use before a person begins treatment, either at a central intake center or inside a program prior to admission. A Treatment Planning Assessment guide and Reassessment guides are in development. That is the legitimate source. Now the part almost nobody explains. The ASAM Criteria is copyrighted, and reproducing it is licensed, not free. [ASAM's copyright and permissions guidance](https://www.asam.org/asam-criteria/copyright-and-permissions) requires a permissions agreement for reusing content from The ASAM Criteria beyond its fair use guidelines, for publishing or marketing use, for training vendors implementing the Criteria, for payers using it in utilization management, for publishers republishing content, and for technology vendors integrating Criteria content into their products. The other side of that line matters too. ASAM states that using the book for clinical decision-making, without publishing or marketing that use, does not require permission. States and policymakers may incorporate it into laws or regulations without permission. And eight specific Fourth Edition figures may be republished at no cost if they are properly cited and the terms are accepted. So when a third-party site offers a "printable ASAM assessment PDF," you are looking at either a Third Edition reproduction, a paraphrase of unclear accuracy, or a licensing problem someone else has decided to inherit. Download the free guide from ASAM instead, and buy the book for the criteria and decision rules the free guide does not replace. There is a 2026-specific version of this issue too. ASAM's condition of access states: "As a condition of your access to The ASAM Criteria and other ASAM intellectual property, you agree not to input such content and information into any artificial intelligence system." If your team is building an AI intake assistant, or pasting clinical documents into a chatbot to summarize them, that sentence applies to you. One more thing, because the opposite advice is circulating. Developing your own version of the assessment, or adding local diagnostic criteria to justify a higher intensity of care, is not a workaround. It creates licensure, payer, and clinical exposure at the same time. ![Matching a patient to the right ASAM level of care](/assets/blog/c-asam-2.webp) Matching a patient to the right ASAM level of care ## How Payers and States Actually Use the ASAM Criteria Most operators know that payers "want ASAM." Fewer know why, which makes it harder to argue a denial. The mechanism is federal. Under CMS Section 1115 substance use disorder demonstrations, [MACPAC documents](https://www.macpac.gov/subtopic/section-1115-waivers-for-substance-use-disorder-treatment/) that between 12 and 24 months after approval, states must ensure residential providers meet ASAM criteria or other nationally recognized, evidence-based, SUD-specific program standards, and that residential providers offer patients access to medication-assisted treatment. In that same window, states must require providers to use an evidence-based, SUD-specific patient assessment tool. Within 24 months, states must establish an independent utilization management approach and an independent process for reviewing placement in residential settings. Read that last requirement again. Independent review of residential placement is a structural feature of the program, not an unusual payer behaviour. It is why a defensible assessment is a reimbursement artefact as well as a clinical record. State licensure moves in the same direction. Illinois is a documented example: [IDHS/SUPR began issuing licenses](https://www.dhs.state.il.us/page.aspx?item=170097) reflecting the Fourth Edition on 1 June 2025, with an effective adoption date of 1 July 2025 for all licensed organizations. Other states run their own timelines, so the edition that governs your program is set by your state agency and your payer contracts rather than by publication date. This is not Medicaid-only either. Commercial behavioral health payers publish [ASAM clinical criteria information](https://public.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/ASAMClinicalCriteriaInformation.html) for their network providers. The practical consequence for utilization review is simple. Documentation that maps clearly and specifically to the dimensions survives review. Documentation that asserts a level of care without showing the multidimensional reasoning behind it does not. ## ASAM Criteria vs ASAM CONTINUUM vs ASAM Level of Care Certification Three different things carry the ASAM name, and operators routinely ask about one while meaning another. | What it is | What it covers | Who it is for | | --- | --- | --- | | **The ASAM Criteria, Fourth Edition** | The clinical standard itself, published in book form. Copyrighted and purchased. | Clinical and utilization review staff | | **Fourth Edition assessment guides** | Free downloadable guides supporting a level of care recommendation. | Intake and clinical interviewers | | **ASAM CONTINUUM** | A software implementation of the Criteria, distinct from the book and the paper guides. | Programs wanting a software-supported workflow | | **ASAM Level of Care Certification** | A facility credential covering adult residential programs at Levels 3.1, 3.5, and 3.7. | Residential operators | The certification is the one most often misunderstood. [ASAM describes it](https://www.asam.org/asam-criteria/level-of-care-certification) as "an independent assessment of a treatment program's ability to deliver services consistent with The ASAM Criteria." CARF International administers it, conducts the onsite surveys, and issues the certification decisions independently. ASAM says the program currently covers adult residential programs at Levels 3.1, 3.5, and 3.7, with planned expansion to adolescent programs, co-occurring enhanced programs, and other levels. Note that the credential is population-specific and level-specific rather than a blanket seal. It verifies that a program can deliver evidence-based treatment matched to patient needs at a named level, which is why the adolescent and co-occurring enhanced versions are being added separately. For payers, ASAM says certification helps "differentiate between various levels of residential care" and can inform prior authorization decisions, reimbursement models, and centers of excellence development. That is the commercial case for pursuing it. It is worth separating this from accreditation generally. ASAM Level of Care Certification is a level-specific credential. It sits alongside broader accreditation such as [Joint Commission accreditation](/joint-commission-accreditation-rehab/) rather than replacing it. ## What This Means for Your Website, Your Admissions Team, and Your Referral Partners Here is the pattern we keep running into when auditing treatment center websites. The clinical team completes the edition transition. The website does not. Level-of-care pages still carry titles like "Partial Hospitalization Program (PHP)" and "Level 3.3." Referral one-pagers still describe a detox track with its own WM numbering. Admissions scripts still walk a caller through a continuum the license no longer matches. Nobody made a decision to leave it that way. It simply was not anyone's job. Four things to reconcile, in this order. 1. **Match your public level-of-care pages to your license.** Whatever level names your state agency uses on your license should be the primary labels on your site. If the license says High-Intensity Outpatient and the page says PHP, the mismatch will surface in an audit or a payer conversation eventually. 2. **Keep the legacy term visible anyway.** Families search for "partial hospitalization," not "high-intensity outpatient." Retiring the old phrase entirely costs you the people looking for you. Lead with the current designation and keep the legacy name in the body copy where it can still be found. This is standard practice in [treatment center content work](/seo/content-marketing-rehab-centers/), and it is one of the few places where clinical accuracy and search visibility genuinely pull in opposite directions. 3. **Update admissions scripts and referral collateral in the same sprint** as the clinical documentation. Referral partners work from whatever version of your materials they last received. If you serve [outpatient and IOP populations](/industries/outpatient-iop-marketing/) or run a [withdrawal management service](/how-to-start-a-detox-center/), those descriptions moved. 4. **Make sure whoever writes your copy knows what your assessment produces.** A page should not describe a level of care your license does not cover. There is a compliance edge to this that is easy to miss. Marketing copy describing levels of care is a regulated surface. Overstating what a program is licensed to deliver is a licensing and FTC problem before it is a marketing problem, which is why we treat level-of-care pages as compliance documents in our [rehab marketing compliance work](/rehab-marketing-compliance-guide/) rather than as ordinary service pages. If you want a second pair of eyes on how your levels of care read to a family, a referral source, and a payer, [request a free strategy audit](/contact/). ## Frequently Asked Questions ### What does ASAM stand for? ASAM stands for the American Society of Addiction Medicine. The ASAM Criteria is the organization's set of clinical guidelines for matching a person with a substance use disorder to the right intensity of treatment, across six assessment dimensions and a continuum of levels of care. The current version is the Fourth Edition. ### What is the difference between the DSM-5 and the ASAM Criteria? The DSM-5 is a diagnostic classification. It establishes whether a substance use disorder is present and how severe it is. The ASAM Criteria is a placement and service-planning standard. It establishes what intensity of care the person needs. They answer different questions and are used together, which is why a severe diagnosis does not automatically mean a high level of care. ### Who is qualified to do an ASAM assessment? ASAM does not specify who may complete the Level of Care Assessment. It says assessors should work within the scope of practice defined by state or other local authority, and generally recommends that assessments are completed by clinical staff. The binding requirement comes from your state licensing board, state Medicaid program, and payer contracts. Several states regulate the clinical supervisor rather than the interviewer. ### What ASAM level is IOP? Intensive outpatient treatment is Level 2.1 in the Fourth Edition. The next step up is Level 2.5, High-Intensity Outpatient Treatment, which the Third Edition called partial hospitalization. Level 2.7, Medically Managed Intensive Outpatient Treatment, adds daily medical oversight to high-intensity outpatient programming. ### What ASAM level is residential treatment? Residential treatment spans Levels 3.1, 3.5, and 3.7. Level 3.1 is clinically managed low-intensity residential treatment. Level 3.5 is clinically managed medium to high intensity residential treatment. Level 3.7 is medically managed residential treatment, meaning residential care under physician-led medical management. Level 3.3 was eliminated in the Fourth Edition. ### Is there a free ASAM criteria PDF? Yes, but only from ASAM. ASAM publishes a free Fourth Edition Level of Care Assessment guide on its own site, along with further guides in development. The Criteria itself is copyrighted, and reproducing it beyond ASAM's fair use guidelines requires a permissions agreement, so third-party "printable ASAM assessment" downloads are not an authorized source. ### Do insurance companies use the ASAM Criteria? Yes. Under CMS Section 1115 SUD demonstrations, states must ensure residential providers meet ASAM criteria or other nationally recognized, evidence-based, SUD-specific program standards, require providers to use an evidence-based SUD-specific assessment tool, and establish independent utilization management and residential placement review. Commercial behavioral health payers also publish ASAM clinical criteria information for network providers. ### Can we put the ASAM Criteria into our AI tools? No. ASAM states that as a condition of your access to The ASAM Criteria and other ASAM intellectual property, you agree not to input that content into any artificial intelligence system. That covers pasting Criteria content into a chatbot and building AI intake or utilization review tools on top of it. Use ASAM's own software and licensed vendors instead. ## Sources 1. American Society of Addiction Medicine. *The ASAM Criteria.* 2. American Society of Addiction Medicine. *The ASAM Criteria 4th Edition.* 3. American Society of Addiction Medicine. *Criteria FAQ.* 4. American Society of Addiction Medicine. *Fourth Edition Assessment Guides.* 5. American Society of Addiction Medicine. *Copyright and Permissions.* 6. American Society of Addiction Medicine. *ASAM Level of Care Certification.* 7. Illinois Department of Human Services. *The ASAM Criteria: Transition from 3rd Edition to 4th Edition.* 8. MACPAC. *Section 1115 Waivers for Substance Use Disorder Treatment.* 9. Pennsylvania Department of Drug and Alcohol Programs. *ASAM Alignment FAQ.* --- Source: https://addictionmarketingagency.com/asam-criteria/ Agency: Addiction Marketing Agency — https://addictionmarketingagency.com/