AKA: ASAM Criteria
A set of guidelines clinicians use to decide what level of care (detox, residential, IOP, outpatient, etc.) a person needs.
In the context of addiction treatment:
Providers rate people across multiple “dimensions” (withdrawal risk, medical issues, mental health, relapse risk, environment, etc.) to justify where they should be treated.
What to know:
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Insurers often rely on ASAM criteria to approve or deny certain levels of care.
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If your level of care is denied, it’s often because the insurer claims you don’t meet ASAM medical necessity.
Example:
A client with severe withdrawal risk, unstable housing, and repeated relapse may meet ASAM criteria for residential instead of standard outpatient.