Addiction Treatment Reform Movement: Evidence-Based Practices
For many of us who have struggled with substance use, the moment we or our families reached out for help felt like stepping into an unfamiliar system with its own unspoken rules. We were vulnerable, often scared, and hoping for support – yet the process that followed rarely involved our voice or our preferences. This blog is meant to offer clarity and empowerment, grounded in personal experience and informed by professional standards that many of us were never told existed.
The Predominant Model: “Tough Love” and Limited Choice
When those of us dependent on substances asked for or needed help, a common scenario unfolded:
- Family members called a treatment center and were referred to an interventionist.
- The interventionist met with the family and devised a plan to send us off to treatment.
- We were then told where to go and what to do.
- If we hesitated or questioned the plan, we were told to “suffer the consequences” until we complied. (Tough love!)
While this is an oversimplification, it reflects a core assumption: that due to addiction, we forfeited our right to participate in decisions about our treatment and recovery. Power was placed entirely in the hands of the interventionist, treatment center, and family – and taken away from the person most affected.
The second assumption in this model is that simply stopping drinking or using is the primary goal. Little attention was given to underlying conditions such as trauma, environment, or living situations that might be driving addiction. Expressions of distress were often dismissed – “get off the pity pot” is a common phrase in AA. While this approach showed some success for certain populations, such as middle-aged white businessmen in corporate settings, it failed many others with different backgrounds, trauma histories, and belief systems.
A New Reform Model: Assessment and Collaboration
Now imagine a different approach: People seek help, qualified professionals conduct thorough assessments based on six ASAM dimensions, and – importantly – they ask for our treatment preferences.
The American Society of Addiction Medicine (ASAM) Criteria
What many of us and our families did not know is that there are professional standards for evaluating and treating substance dependence – the ASAM standards.
First published in 1991, The ASAM Criteria 4th Edition is:
A comprehensive set of standards and decision rules that use a holistic, person-centered approach to determining the appropriate level of care and developing treatment plans for patients with addiction and co-occurring conditions.
These revised standards were crafted using a rigorous scientific review process and consensus development.
It sounds ideal – but this process was not offered to many of us. Instead, we were sent off to a predetermined program without assessment or collaboration. It’s time to become informed and assert our right to treatment that aligns with ASAM standards, rather than accepting decisions made solely by interventionists or institutions. We deserve professional, evidence-based care – and respect.
The Treatment Reform Movement
As shared in an earlier blog, parents who lost children to opioid overdoses began demanding evidence-based treatment. Their advocacy led to research centers evaluating treatment approaches, including Medication-Assisted Treatment (MAT). These advocates aligned with other reform groups, fueling a broader movement to improve treatment outcomes across justice systems and high-income communities.
What are evidence-based practices and where can we find them?
See here.
Adhering to ASAM standards is central to this reform movement because the standards provide transparency and understanding – for both individuals and families. Treatment no longer has to feel mysterious, overwhelming, or beyond our comprehension. Instead, we gain a clearer picture of what is driving addiction and a plan to address those drivers to reduce relapse and support long-term recovery.
The Bottom Line
Using ASAM criteria allows for a comprehensive assessment of our needs, services tailored to meet those needs, and a baseline for measuring progress. In the event of relapse, it guides adjustments to the recovery plan rather than assigning blame or shame.
In truth, many of us did not require inpatient treatment, and our families spent money and emotional energy that could have been directed toward intensive community-based care. Understanding ASAM criteria gives us power and prevents unnecessary suffering.
Now let’s take a closer look.
The ASAM Criteria Dimensions and Subdimensions[i] to Evaluate Substance Users
Dimension 1: Intoxication, Withdrawal and Addiction Medications
- Intoxication and associated risks
- Withdrawal and associated risks
- Addiction medicine needs
Dimension 2: Biomedical Conditions
- Physical health concerns
- Pregnancy related concerns
- Sleep problems
Dimension 3: Psychiatric and Cognitive Conditions
- Active psychiatric concerns
- Persistent disability
- Cognitive functioning
- Trauma exposure and related needs
- Psychiatric and cognitive history paragraph
Dimension 4: Substance Use Related Risks
- Likelihood of risky substance use
- Likelihood of risky substance related behaviors
Dimension 5: Recovery Environment Interactions
- Ability to function in current environment
- Safety in current environment
- Support in current environment
- Cultural perceptions of substance use
Dimension 6: Person Centered Considerations
- Patient preferences
- Barriers to care
- Need for motivational enhancement
This comprehensive evaluation allows both the patient and family to understand treatment needs and track progress. It offers a more balanced view of the individual – moving beyond labels like “addict” or “alcoholic.” Instead of focusing on judgment, ASAM helps families understand challenges and collaborate on recovery. Unlike traditional approaches such as Al-Anon and AA, this model treats addiction as a shared family issue, fostering connection rather than isolation.
The Power of Patient Preference
Dimension 6 – Patient Preferences – marks one of the most significant shifts between the old model and the new. Instead of being told what to do and where to go, we are asked how professionals and families can support us. Our perspective matters because recovery requires engagement, not submission.
There are, of course, exceptions for situations requiring immediate detox or urgent medical care. But for many of us, the path to sustainable recovery begins with being included in the conversation.
[i] American Society of Addiction Medicine. https://www.asam.org/asam-criteria