• American Society of Addiction Medicine (ASAM)

    Provided by: Wellness Grove
  • Client Date of Birth*
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  • ASAM

  • The ASAM Criteria's strength-based multidimensional assessment takes into account a patient's needs, obstacles and liabilities, as well as their strengths, assets, resources, and support structure. This information is used to determine the appropriate level of care across a continuum. Please make a selection on the level applicable for each dimension.

    Each of the dimensions provided in the grid below are described as follows:

    • D1 (Dimension 1): Acute Intoxication and/or Withdrawal Potential
    • D2 (Dimension 2): Biomedical Conditions and Complications
    • D3 (Dimension 3): Emotional, Behavioral, or Cognitive Conditions and Complications
    • D4 (Dimension 4): Readiness to Change
    • D5 (Dimension 5): Relapse, Continued Use, or Continued Problem Potential
    • D6 (Dimension 6): Recovery/Living Environment
  • Rows
  • Acknowledge & Sign

  • Date*
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