ASAM assessment: how to complete one, step by step, with an example

What an ASAM assessment decides

It answers one question at a time: what level of care does this person need now? At admission, it sets the level; at each review, it decides whether they still need it; at the end, whether they're ready to step down. Payers read it to authorize days, and Texas Medicaid ties substance use levels of care to the current ASAM Criteria (TMPPM Behavioral Health handbook).

The 4th edition separates two pieces of work. Its level of care assessment gathers what's needed to recommend a level, and its results are applied to the dimensional admission criteria for each level. The fuller treatment planning assessment is the complete biopsychosocial picture behind the treatment plan (ASAM level of care assessment guide). Many outpatient programs, ours included, do both in one intake. This page is about the first; the second is in our biopsychosocial assessment guide. The six dimensions, the rating scale and the levels themselves are summarized in the ASAM Criteria cheat sheet, so they aren't repeated here.

Before the interview

• Know which edition and form the payer uses. Some plans and states still work from the 3rd edition, whose dimensions are numbered differently. Use the form the reviewer will read.
• Have the screen in hand: the reason for the call, last use, withdrawal and overdose history, medications and any safety flags from the pre-admission screening.
• Get releases signed for recent providers (detox, hospital, prescriber) so their records can back up what the person tells you. For substance use records, that means a 42 CFR Part 2 consent.
• Be ready to measure withdrawal if it's possible: a scale such as the CIWA-Ar for alcohol or the COWS for opioids, given by someone trained to use it, and vital signs if medical staff are on site.
• Have the guide that matches your edition. ASAM publishes a free 3rd edition interview guide and 4th edition level of care assessment guides; where to get them is in the cheat sheet.

The steps

1. Start with immediate safety: dimensions 1, 2 and 3

Ask about intoxication and withdrawal, physical health, and mental health and safety first, because a high enough need in any of them settles the question. ASAM's 4th edition guide lets the interviewer stop after dimensions 1 to 3 if the person already meets criteria for a minimum of Level 3.7 (including its biomedically enhanced and co-occurring enhanced forms) in any subdimension; the rest can wait for the receiving program, or continue if the person can take part and the information is needed (ASAM level of care assessment guide). For an outpatient program, that is the moment to arrange the transfer, not to finish the form. A positive suicide screen gets a response the same day, whatever the level.

2. Then substance use-related risks and the recovery environment: dimensions 4 and 5

Ask what happens when the person tries to stop or cut down, how past treatment ended, how strong the cravings are, and what home, relationships, work and legal pressures do for or against recovery. These two dimensions decide most outpatient placements: the difference between weekly therapy, IOP and a day program usually lives here.

3. Then person-centered considerations: dimension 6

Ask what the person wants from treatment, what they're willing and able to attend, and what gets in the way: transportation, childcare, work, cost, language, past experiences of care. In the 4th edition this dimension isn't one more risk score; the assessor uses shared decision-making to find the level the person is willing and able to engage in (ASAM, level-of-care assessment: a practical guide). Readiness to change is no longer its own dimension; it's weighed inside the others.

4. Rate each dimension, with the fact behind the rating

Give each dimension (in the 4th edition, each subdimension the form asks for) a risk rating on the scale your form uses, and write the fact that earned it next to it: "D4: 3. Two IOP episodes in 18 months, each ending in use within 3 weeks; cravings 9 of 10 daily." A rating with no fact can't be checked, and a reviewer won't accept it. Rate today's risk; history counts only for what it says about now.

5. Match the ratings to a level

Compare the ratings in dimensions 1 to 5 with each level's dimensional admission criteria. As ASAM's guide frames it, you identify the most intensive level of care any of the ratings meets: a lower level would leave that need unmet, so that's the least intensive level that's safe for the person as a whole. Then write why the next level down won't do. That one sentence is what payers look for first, at admission and in every continued-stay review.

6. Agree on the plan with the person, and record any gap

Bring the recommendation back to dimension 6. If the person agrees, the recommended level and the level of care provided are the same. If they don't, or the level isn't available nearby, record both, the reason for the difference, and what you'll do to lower the risk in the meantime (a referral, a wait-list, more frequent contact). Never place someone at the level you happen to offer and write the ratings to fit.

7. Write it up and sign it

The written assessment is a short paragraph per dimension (facts, rating, what it calls for), then the level, why not lower, why not higher, the person's own view, and the reassessment date. The summary form below has the layout. In a licensed Texas program, the assessment is signed by a qualified credentialed counselor within 3 individual service days.

8. Reassess

At each treatment plan review, before an authorization runs out, and whenever something changes: a lapse, a new diagnosis, a move, a lost job. Each reassessment says which ratings went up, down or held since last time, and why. Start the review 5 days before the authorization ends; our ASAM continued-stay documentation guide has the full write-up with weak and strong examples.

Interview questions by dimension

Our own prompts, in plain words, for an adult intake; they don't replace the published interview guides. Ask open questions first and pin down numbers and dates after.

Dimension (4th edition)	Questions to ask
1. Intoxication, withdrawal and addiction medications	When did you last drink or use, and how much? What happens to your body when you stop: shakes, sweats, seizures, hallucinations? Have you ever needed detox? Are you on buprenorphine, methadone, naltrexone or another medication for use, and is it working?
2. Biomedical conditions	What health problems do you have, and are they being treated? What medications do you take? Any pain, pregnancy, recent ER visits or hospital stays? Who is your doctor?
3. Psychiatric and cognitive conditions	How has your mood been? Any anxiety, trauma, voices or paranoia, with or without using? Have you thought about hurting or killing yourself, or someone else? Any trouble with memory, concentration or reading? Past psychiatric care?
4. Substance use-related risks	What happened the last time you tried to stop or cut down? How strong are cravings, from 0 to 10, and how often? When are you most likely to use? What has helped before? What happens if you keep using: overdose, health, job, family?
5. Recovery environment interactions	Where do you live, and does anyone there drink or use? Who in your life supports your recovery? How are work, school and money? Any court, probation, CPS or custody issues? How would you get here?
6. Person-centered considerations	What do you want to be different? What would make it hard to come: work, kids, transport, cost? What has treatment been like for you before? What schedule could you actually keep? What matters most to you right now?

A made-up example, start to finish

Client J., 33, comes to an outpatient program after an emergency room visit for chest pain two weeks ago (cardiac work-up negative). He uses methamphetamine and alcohol. Ratings use the 0-to-4 scale most forms use; the reasoning is ours, for illustration.

Dimension	What the interview found	Rating
1	Smokes methamphetamine daily, about a gram; last use yesterday afternoon. Drinks 6 to 8 beers on weekends "to come down"; last drink 3 days ago. No history of alcohol withdrawal, seizures or detox. Sleeps 12 hours after binges.	1, mild
2	Lost about 20 pounds in 3 months; dental pain; no primary care doctor. ER work-up two weeks ago normal.	1, mild
3	Paranoia while using ("the neighbors were watching me") that clears within days of stopping; none today. PHQ-9 of 13. Nightmares since an assault at 19. Suicide screen negative. No psychiatric care ever.	2, moderate
4	Two IOP episodes in 18 months, each ending in use within 3 weeks. Cravings 9 of 10 daily. Longest time without methamphetamine since 25: 3 weeks.	3, significant
5	Sleeps on a friend's couch; the friend uses. Partner left last month. Construction work is irregular; a job starts in 3 weeks. No legal issues. No car. A brother offers a room 40 minutes away.	3, significant
6	"I want my life back." Won't go to residential: he'd lose the job offer and has a dog. Open to a recovery residence. Can attend days for the next 3 weeks, evenings after that.	Preferences and barriers, not scored

Read the summary as a reviewer would: every rating has a fact, the "why not lower" names the dimensions, and the plan says what would change the decision. The treatment plan then takes D4 and D5 as its first two problems; see the SUD treatment plan guide.

What would change the level

Same client, one fact different. This is how one dimension moves a placement:

If this were true	What changes
He drank daily and had a withdrawal seizure last year	D1 rises. Withdrawal management comes first, at a level that provides it with medical oversight (the 4th edition builds it into levels such as 1.7, 2.7 and 3.7, by severity).
He had a plan to kill himself and access to a gun	D3 is severe. An emergency psychiatric evaluation today, before any outpatient placement.
He moved into his brother's sober home and had a ride every day	D5 drops. With D4 still high, 2.5 may still fit; if cravings and lapses also eased, 2.1 might be enough.
He refused the recovery residence and had nowhere else to go	D5 stays high and residential care is indicated. If he declines it, record the recommended level, the level he accepted, the reason, and the plan to reduce risk.

An ASAM assessment summary form to copy

Paste this into your EHR's template or a document and fill every line. It works with either edition: write the dimension names your form uses.

Texas rules that touch the ASAM assessment

• It's part of the comprehensive assessment. In a licensed chemical dependency treatment facility, a counselor or counselor intern completes the assessment, and a QCC signs it within 3 individual service days of admission (26 TAC §564.803). Many programs put the ASAM ratings and level in that same document.
• By video, with conditions. The rule allows assessment by synchronous audio and video; audio-only only during a declared state of disaster under its conditions; and in person if the client asks or doesn't consent to an electronic assessment.
• Texas Medicaid's H0001 is a multi-dimensional assessment on admission, by a QCC or intern and signed off by a QCC, once per episode of care (TMPPM).
• A level change (PHP to IOP, IOP to outpatient) needs a QCC-signed decision with the rationale and effective date, and a revised plan (26 TAC §564.804(k)).

The rest of chapter 564, from screening to discharge, is summarized in Cima Consulting's 26 TAC 564 guide.

Mistakes that get placements questioned

• Finishing the form before handling danger. A high dimension 1 or 3 need is a transfer or an emergency, not a paragraph.
• No withdrawal measure when withdrawal was possible: "denies withdrawal" with no scale, no vitals and no plan if symptoms start.
• Scoring dimension 6 like a risk and using it to raise or lower the level, instead of shaping the plan with the person.
• No "why not lower" sentence, or one that doesn't name a dimension.
• Ratings that never change across reviews, or that change with no new fact.
• No collateral when it was available: no records from the detox the person just left, no call to the prescriber, with releases signed.
• A recommended level that wasn't provided with no reason recorded and no plan to close the gap.

ASAM assessments in Cima

On Cima's Program plan for IOP and PHP, the biopsychosocial assessment includes ASAM dimensions 1 to 6 with a risk rating for each, and the continued-stay review has a required section for the six dimensions next to progress, current risks, why a lower level can't safely do it, and the step-down plan. A section too thin to mean anything blocks signing, with a message saying which. Every authorization ending in the next 5 days shows on the clinician's Today screen under UR due. PHP, IOP and outpatient are levels on one chart, so a level change keeps the history together. With AI help turned on by the practice owner, Cima drafts the sections from your own shorthand and leaves a section empty rather than guess. The Program plan covers up to 25 clients in the program, and each added clinician is $39 a month; see Cima for IOP and PHP programs and pricing.

Questions

What is an ASAM assessment?

A structured interview that gathers facts in the six dimensions of The ASAM Criteria, rates the risk in each, and matches the ratings to a level of care's admission criteria, to recommend the least intensive level where the person can be treated safely and effectively.

How do you complete an ASAM assessment?

Check immediate safety first (dimensions 1 to 3), then substance use-related risks and the recovery environment (4 and 5), then the person's preferences and barriers (6). Rate each with a fact behind it, match the ratings to a level, write why a lower level won't do, agree on the plan with the person, sign it, and reassess at each review.

Who can do an ASAM assessment?

A clinician trained in The ASAM Criteria, within their license. Payers set their own rules. In a licensed Texas chemical dependency treatment facility, a counselor or counselor intern does it as part of the comprehensive assessment and a qualified credentialed counselor signs it within 3 individual service days.

How does the ASAM assessment determine the level of care?

The ratings in dimensions 1 to 5 are compared with each level's dimensional admission criteria; the level is the most intensive one any rating calls for, which is the least intensive level that's safe overall. Dimension 6 shapes the final plan with the person through shared decision-making.

What's the difference between an ASAM assessment and a biopsychosocial assessment?

The ASAM level of care assessment rates risk to recommend a level. The biopsychosocial assessment is the full history and current picture behind the treatment plan. ASAM's 4th edition treats them as two pieces of work; many programs do both in one intake.

Is there a free ASAM assessment form?

ASAM publishes a free 3rd edition interview guide and 4th edition level of care assessment guides on asam.org. A program's own form also works if it covers every dimension, rates each with facts, and explains the level. The summary form on this page is free to copy.

How long does an ASAM assessment take?

No rule sets a length; it depends on the person and how much is already known from screening and records. The 4th edition guide allows stopping after dimensions 1 to 3 when the person already needs Level 3.7 or higher.

How often is the ASAM reassessed?

At every treatment plan review, before each authorization ends, and whenever something important changes, such as a lapse, a move or a new diagnosis. Each reassessment says which ratings changed and why.

Can an ASAM assessment be done by telehealth?

Often, if the payer allows it. Texas chemical dependency facilities may assess by synchronous audio and video; audio-only only during a declared disaster under the rule's conditions; in person if the client asks.

What if the recommended level of care isn't available?

Record the recommended level, the level provided, and why they differ, and what you're doing to lower the risk meanwhile: a referral, a wait-list, more contact. Don't rewrite the ratings to fit the level you have.

Is the ASAM assessment used for mental health only clients?

No. The ASAM Criteria are for substance use and co-occurring conditions. Mental-health-only levels of care are reviewed against each payer's own medical-necessity criteria.

Sources

• American Society of Addiction Medicine, The ASAM Criteria, Fourth Edition, level of care assessment guide (level of care vs. treatment planning assessment, early stop at Level 3.7, matching ratings to levels).
• American Society of Addiction Medicine, The ASAM Criteria, Fourth Edition, Volume 1: Adults, overview; The ASAM Criteria and level-of-care assessment: a practical guide (dimension 6 and shared decision-making); Criteria FAQ.
• American Society of Addiction Medicine, The ASAM Criteria, 4th edition.
• 26 Texas Administrative Code §564.803 (assessment) and §564.804 (treatment planning and level-of-care changes), as of October 2026. §564.803 · §564.804
• TMHP, Texas Medicaid Provider Procedures Manual, Behavioral Health handbook, October 2026 (H0001; ASAM-based levels of care).

"The ASAM Criteria" is ASAM's registered trademark and copyrighted work. This page is an independent guide in our own words, not affiliated with or endorsed by ASAM; dimension names are used for reference. General information, not clinical, legal or billing advice.