In an earlier post, I outlined how the approach to addiction treatment is shifting. Traditionally, when someone needed help, families often turned to an interventionist who arranged a 28-day inpatient stay.
- The emerging reform model takes a very different path!!!
Instead of defaulting to a set program, qualified professionals now conduct comprehensive assessments using the six ASAM dimensions, engaging individuals in discussions about their treatment preferences. The results of these assessments guide both the level and location of care, ensuring that treatment intensity matches each person’s unique needs. In essence, the ASAM standards connect assessment directly to treatment, making the evaluation process the foundation for effective recovery planning.
ASSESSMENTS DRIVE THE TREATMENT PLAN AND SERVICE LOCATION
American Society of Addiction Medicine (ASAM) Criteria
Most of us and our families never heard of the ASAM standards, we were simply sent off to treatment. First published in 1991, The ASAM Criteria 4th Addition[i], 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.
The revised standards have been crafted using a rigorous methodology for scientific evidence review and consensus development.[ii]
While I have discussed these standards before, I feel it is necessary to review them because few parents or users seeking help have heard of ASAM. Fewer still have been assessed and treated per the six dimensions.
Assuming your loved one was not sent off for the magical 28 day cure and you are considering treatment options, let’s take a look at the ASAM placement categories, also known as the Continuum of Care with 4 levels (4 being the most intense treatment option while 1 offers minimal oversight).
When discussing placement, these options should prompt you to ask for detailed information about the level of service recommended to you and why it is a fit for your loved one. With the exception of Recovery Residences, this is only an outline of the Continuum of Care, as the reader can look up ASAM on the web and find descriptions for each level and sub-level. The purpose of this blog is to inform the reader as to the existence of these standards because many of us and our families never heard of ASAM. It is time to bring treatment into the world of professional evaluations and clinical, evidence-based standards. The levels are as follows:
Level 4: Inpatient
• Medically managed inpatient – for individuals who need 24-hour medical care and stabilization.
Level 3: Residential
• 3.1 Clinically managed low residential – structured living with therapeutic support.
• 3.5 Clinically managed high residential – for those needing more supervision and therapy.
• 3.7 Medically managed residential – integrates medical oversight with clinical services.
Recovery Residences
• From clinical to peer-run homes, offering progressively lower levels of supervision and greater independence.
Level 2: Intensive Outpatient (IOP/HIOP)
• Ranges from standard to medically managed programs, for those who can live at home but need frequent therapy and monitoring.
Level 1: Outpatient
• Outpatient and medically managed outpatient care designed for ongoing therapy or relapse prevention.
Addition: Long term remission monitoring is a recent addition that reflects the programs for physicians and pilots known for its outstanding success rates.
It’s worth asking: how often are patients or families actually presented with these options? Too often, the answer is “never.” When treatment decisions are made without reference to ASAM standards or a thorough professional assessment, the result can be unnecessary harm – for both the individual and their loved ones. In a field where relapse can have serious consequences, failing to follow established clinical standards isn’t just outdated; it’s negligent. It’s malpractice.
Observations on Placement Considerations
When navigating placement decisions, several key situations can arise. Understanding how to respond can make a meaningful difference for both the individual and their family.
1. Relapse – Reevaluate
If your loved one begins struggling in their current setting, it’s time to revisit the original assessment. Professionals should help determine whether the placement still aligns with the person’s needs and what additional services might now be appropriate. The next step is to identify new services that offers the right level of structure and support. Remember, recovery is often a process of trial and error, not trial and success – persistence and reassessment are part of the journey.
2. Crisis Situations – Passed Out or Acting Out
When your loved one is unresponsive, passed out, or otherwise in medical distress, don’t hesitate to call 911. Families often fear embarrassment or backlash, but this is a medical emergency, and immediate help can be lifesaving.
If your loved one is agitated, acting erratically, or displaying menacing behavior, call 988, the Mental Health Crisis Line. These teams are trained in de-escalation and can often provide a safer, more appropriate response than traditional law enforcement.
In either case, document what happens – use your phone to record evidence if it’s safe to do so, and obtain copies of any EMT or police reports. This documentation can be crucial for family members, professionals, or trustees involved in treatment and care decisions.
3. Recovery Residences – Buyer Beware
The landscape of recovery housing can be confusing. After inpatient treatment, families are often overwhelmed by the variety of options and uncertain about what each provides. Tensions can arise when expectations differ:
- Parents, who often pay the bills, expect accountability, safety, and meaningful support.
- Some sober homes and halfway houses prioritize profit, offering minimal services at high cost.
For this reason, families should gather detailed, written information about the services, staffing, and oversight provided at any prospective residence. Always request a signed contract outlining the terms – transparency and documentation protect everyone involved.
ASAM Framework for Analyzing Recovery Residences
Recovery Residences are home-like environments where individuals can continue building the interpersonal and life skills essential for sustained recovery. The ASAM framework identifies four primary types of Recovery Residences, each offering different levels of structure and professional involvement:
1. Clinical Recovery Residences (RR Type C Programs)
These programs integrate the social and medical models of recovery, combining peer support with professional clinical services. (Note: This is the only type of Recovery Residence that meets ASAM Level 3.1 criteria –ie, the only one with clinical supervision, see below.)
2. Supervised Recovery Residences (RR Type S Programs)
Staffed by trained and credentialed personnel, these residences provide structured schedules and life-skills programming, but do not offer clinical treatment services.
3. Monitored Recovery Residences (RR Type M Programs)
Often referred to as “sober homes,” these settings rely on peer accountability and house rules to create a safe environment. No professional services are provided.
4. Peer-Run Recovery Residences (RR Type P Programs)
These are democratically managed homes where residents elect their own leaders and govern themselves. Like monitored residences, no clinical or professional services are offered.
Clinical Residences: A Safer Choice
Clinical Recovery Residences (RR Type C) offer significant advantages, particularly for individuals newly entering recovery. These programs coordinate medical appointments, manage medication-assisted treatment, and ensure communication with outside providers. For vulnerable adults, the presence of professional oversight can also reduce risks such as exploitation or exposure to substance use within the home. For these reasons, Clinical Residences are often the preferred option for families seeking structure and accountability during the transition from inpatient care to independent living.
Ultimately, the goal is empowerment – for families and individuals to understand that recovery placement is not a guessing game but a clinical decision guided by professional standards. The ASAM framework exists to ensure that care is matched to need, and that recovery unfolds within safe, supportive, and evidence-based environments.
Too many families have sent loved ones “off to treatment” without the knowledge or language to ask the right questions. That time should end here. By learning the ASAM standards and insisting on their use in evaluation and placement, families reclaim their role as informed advocates – helping ensure that hope, healing, and accountability are part of every recovery journey.
[i] https://www.asam.org/asam-criteria/about-the-asam-criteria
[ii] www.asam.org/asam-criteria