What Are the Six Dimensions of ASAM?

ASAM recognizes many dimensions associated with substance abuse.
ASAM recognizes many dimensions associated with substance abuse. (Image: Comstock/Comstock/Getty Images)

The American Society of Addiction Medicine (ASAM) has ascribed six exploratory dimensions to substance abuse treatment and its continuum of care. They were created to help substance abuse professionals evaluate addicts individually according to lifestyle and emotional and psychological hindrances to recovery. The dimensions act as guidelines for treatment admission placement, continuing care needs and appropriate discharge from structured treatment.

Patient Risks

The first ASAM criterion assesses risks to patients associated with the physiological effects of acute intoxication and the potential to experience drug withdrawal symptoms. This criterion helps caregivers determine what detoxification services are needed. Substance abuse interventionists evaluate patients to ascertain the types of drugs used, withdrawal history, any displays of current withdrawal symptoms and whether there is a withdrawal support system in the addict's home.

Physical Complications

The second ASAM dimension is titled "biomedical conditions and complications." These include any medical conditions a patient may have outside of addiction that may complicate detoxification and withdrawal. These complications may negatively influence or interfere with drug treatment. For instance, a patient who suffers from severe pain may have legitimately prescribed narcotics he cannot stop taking completely. In this instance, treatment would be altered to teach the addict how to use his prescription medications safely.

Psychological Impact

ASAM's third dimension is titled "emotional, behavioral or cognitive conditions and complications." It assumes that before effective treatment can take a stronghold, behavioral disorders, emotional malcontent and/or psychiatric illness must be addressed. For instance, if a patient uses drugs to self-medicate feelings of depression, then if depression is not treated separately, it is likely to cause a relapse after treatment

Readiness to Change

The fourth dimension of ASAM recognizes that patients who are court-appointed to treatment or somehow otherwise coerced will not commit to recovery until they are personally ready to accept change. Patients in denial are appointed to a stage of treatment called "pre-contemplation" that readies them for acceptance of the presence of an addiction. Motivational strategies are then used to help the person progress to the "preparation" stage so treatment can begin.

Relapse Assessment

The fifth dimension of ASAM is "relapse, continued use or continued problem potential." This dimension requires substance abuse therapists to conduct assessments looking for prescribed medication compliance, relapse history and current craving levels. This information equips them to help patients recognize situations or feelings that may provoke relapse. They also give addicts coping skills for cravings and destructive behavior.

Recovery Support

"Recovery and Living Environment" is ASAM's sixth dimension. It mandates that before releasing addicts from treatment services, therapists must assess patients' personal influences. Court orders serve as useful motivators to stay clean. In the absence of this, a system of supportive friends and family is often necessary to prevent relapse. If patients do not have a support system, therapists make alternate recommendations.

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