ASAM

Question 1

What is Dimension 1 of the ASAM?

Answer 1

Acute Intoxication and/or Withdrawal Potential

Question 2

What is Dimension 2 of the ASAM?

Answer 2

Biomedical Conditions and Complications

Question 3

What is Dimension 3 of the ASAM?

Answer 3

Emotional, Behavioral, or Cognitive Conditions and Complications

Question 4

What is Dimension 4 of the ASAM?

Answer 4

Readiness to Change

Question 5

What is Dimension 5 of the ASAM?

Answer 5

Relapse, Continued Use, or Continued Problem Potential

Question 6

What is Dimension 6 of the ASAM?

Answer 6

Recovery/Living Environment

Question 7

What is a good question to consider when assessing Dimension 1?

A. What risk is associated with the patient’s current level of acute intoxication?

B. Are there current signs of withdrawal?

C. Are intoxication management services needed to address acute intoxication?

D. All of the above.

Answer 7

D. All of the above.

Question 8

What is a good question to consider when assessing Dimension 2?

A. Are there current psychiatric illnesses or psychological, behavioral, emotional, or cognitive conditions that need to be addressed because they create risk or complicate treatment?

B. Are there current physical illnesses, other than withdrawal, that need to be addressed due to their risk or potential for treatment?

C. How ready, willing, or able does the patient feel to make changes to his or her substance using or addictive behaviors?

D. All of the above.

Answer 8

B. Are there current physical illnesses, other than withdrawal, that need to be addressed due to their risk or potential for treatment?

Question 9

What is a good question to consider when assessing Dimension 3?

A. Is the patient able to manage the activities of daily living?

B. Can he or she cope with any emotional, behavioral, or cognitive conditions?

C. Are there chronic conditions that need stabilization or ongoing treatment (eg, bipolar disorder or chronic anxiety)?

D. All of the above.

Answer 9

D. All of the above.

Question 10

What is a good question to consider when assessing Dimension 4?

A. How aware is the patient of the relationship between his or her alcohol, tobacco, or other drug use or behaviors involved in the pathological pursuit of reward or relief and his or her negative life consequences?

B. Is the patient in immediate danger of continued severe mental health distress and/or alcohol, tobacco, and/or other drug use?

C. Have addiction and/or psychotropic medications assisted in recovery before?

D. Does the individual have supportive friendships, financial resources, or educational or vocational resources that can increase the likelihood of successful recovery?

Answer 10

A. How aware is the patient of the relationship between his or her alcohol, tobacco, or other drug use or behaviors involved in the pathological pursuit of reward or relief and his or her negative life consequences?

Question 11

Which of the below is a risk domain within Dimension 3?

A. Ability to maintain a job.

B. Social functioning.

C. Amount of use.

D. Potential for co-occurring disorders.

Answer 11

B. Social functioning.

The other risk domains are:
- Dangerousness/lethality
- Interference with addiction recovery efforts
- Social functioning
- Ability for self-care
- Course of illness

Question 12

What is a good question to consider when assessing Dimension 5?

A. Are there transportation, childcare, housing, or employment issues that need to be clarified and addressed?

B. Do any family members, significant others, living situations, or school or work situations pose a threat to the person’s safety or engagement in treatment?

C. How well can the patient cope with negative affects, peer pressure, and stress without recurrence of addictive thinking and behavior?

D. All of the above.

Answer 12

C. How well can the patient cope with negative affects, peer pressure, and stress without recurrence of addictive thinking and behavior?

Question 13

What is a good question to consider when assessing Dimension 6?

A. Does the individual have supportive friendships, financial resources, or educational or vocational resources that can increase the likelihood of successful recovery?

B. Have addiction and/or psychotropic medications assisted in recovery before?

C. How aware is the patient of relapse triggers and skills to control addiction impulses or impulses to harm self or others?

D. How aware is the patient of the relationship between his or her alcohol, tobacco, or other drug use or behaviors involved in the pathological pursuit or reward or relief and his or her negative life consequences?

Answer 13

A. Does the individual have supportive friendships, financial resources, or educational or vocational resources that can increase the likelihood of successful recovery?

Question 14

A risk rating of 0 indicates:

A. Issues of utmost severity. The patient would present with critical impairments in coping and functioning, with signs and symptoms, indicating an “imminent danger” concern.

B. A mildly difficult issue, or present minor signs and symptoms. Any existing chronic issues or problems would be able to be resolved in a short period of time.

C. A non-issue or very low-risk issue. The patient would present no current risk and any chronic issues would be mostly or entirely stabilized.

D. Moderate difficulty in functioning. However, even with moderate impairment, or somewhat persistent chronic issues, relevant skills, or support systems may be present.

Answer 14

C. A non-issue or very low-risk issue. The patient would present no current risk and any chronic issues would be mostly or entirely stabilized.

Question 15

A risk rating of 1 indicates:

A. A non-issue or very low-risk issue. The patient would present no current risk and any chronic issues would be mostly or entirely stabilized.

B. A serious issue or difficulty coping within a given dimension. A patient presenting at this level of risk may be considered in or near “imminent danger.

C. Moderate difficulty in functioning. However, even with moderate impairment, or somewhat persistent chronic issues, relevant skills, or support systems may be present.

D. A mildly difficult issue, or present minor signs and symptoms. Any existing chronic issues or problems would be able to be resolved in a short period of time.

Answer 15

D. A mildly difficult issue, or present minor signs and symptoms. Any existing chronic issues or problems would be able to be resolved in a short period of time.

Question 16

A risk rating of 2 indicates:

A. Issues of utmost severity. The patient would present with critical impairments in coping and functioning, with signs and symptoms, indicating an “imminent danger” concern.

B. A serious issue or difficulty coping within a given dimension. A patient presenting at this level of risk may be considered in or near “imminent danger.

C. A mildly difficult issue, or present minor signs and symptoms. Any existing chronic issues or problems would be able to be resolved in a short period of time.

D. Moderate difficulty in functioning. However, even with moderate impairment, or somewhat persistent chronic issues, relevant skills, or support systems may be present.

Answer 16

D. Moderate difficulty in functioning. However, even with moderate impairment, or somewhat persistent chronic issues, relevant skills, or support systems may be present.

Question 17

A risk rating of 3 indicates:

A. Moderate difficulty in functioning. However, even with moderate impairment, or somewhat persistent chronic issues, relevant skills, or support systems may be present.

B. Issues of utmost severity. The patient would present with critical impairments in coping and functioning, with signs and symptoms, indicating an “imminent danger” concern.

C. A mildly difficult issue, or present minor signs and symptoms. Any existing chronic issues or problems would be able to be resolved in a short period of time.

D. A serious issue or difficulty coping within a given dimension. A patient presenting at this level of risk may be considered in or near “imminent danger.

Answer 17

D. A serious issue or difficulty coping within a given dimension. A patient presenting at this level of risk may be considered in or near “imminent danger.

Question 18

A risk rating of 4 indicates:

A. Issues of utmost severity. The patient would present with critical impairments in coping and functioning, with signs and symptoms, indicating an “imminent danger” concern.

B. A serious issue or difficulty coping within a given dimension. A patient presenting at this level of risk may be considered in or near “imminent danger.

C. Moderate difficulty in functioning. However, even with moderate impairment, or somewhat persistent chronic issues, relevant skills, or support systems may be present.

D. A mildly difficult issue, or present minor signs and symptoms. Any existing chronic issues or problems would be able to be resolved in a short period of time.

Answer 18

A. Issues of utmost severity. The patient would present with critical impairments in coping and functioning, with signs and symptoms, indicating an “imminent danger” concern.

Question 19

For Dimension 1, rate the level of risk for the patient: The patient demonstrated adequate ability to tolerate and cope with withdrawal discomfort. Mild to moderate intoxication signs and symptoms interfere with daily functioning, but do not pose imminent danger to self or others.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 19

D. Risk rating 1

Question 20

For Dimension 1, rate the level of risk for the patient: The patient demonstrates poor ability to tolerate and cope with withdrawal discomfort. Severe signs and symptoms of intoxication indicate that the patient may pose an imminent danger to self or others, and intoxication has not abated at less intensive levels of service.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 20

B. Risk rating 3

Question 21

For Dimension 1, rate the level of risk for the patient: The patient is incapacitated with severe signs and symptoms. Severe withdrawal presents danger, such as seizures. Continued use poses an imminent threat to life.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 21

A. Risk rating 4

Question 22

For Dimension 1, rate the level of risk for the patient: The patient is fully functioning and demonstrates good ability to tolerate and cope with withdrawal discomfort. No signs or symptoms of intoxication or withdrawal are present, or signs and symptoms are resolving.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 22

E. Risk rating 0

Question 23

For Dimension 1, rate the level of risk for the patient: The patient has some difficulty tolerating and coping with withdrawal discomfort. Intoxication may be severe, but responds to support and treatment sufficiently that the patient does not pose an imminent danger to self or others.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 23

C. Risk rating 2

Question 24

For Dimension 2, rate the level of risk for the patient: The patient demonstrates poor ability to tolerate and cope with physical problems, and/or his or her general health condition is poor. Patient has serious medical problems, which he or she neglects during outpatient or intensive outpatient treatment.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 24

B. Risk rating 3

Question 25

For Dimension 2, rate the level of risk for the patient: The patient is incapacitated, with severe medical problems (such as extreme pain, uncontrolled diabetes, GI bleeding, or infection requiring IV antibiotics).

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 25

A. Risk rating 4

Question 26

For Dimension 2, rate the level of risk for the patient: The patient is fully functioning and demonstrates good ability to cope with physical discomfort. No biomedical signs or symptoms are present, or biomedical problems are stable.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 26

E. Risk rating 0

Question 27

For Dimension 2, rate the level of risk for the patient: The patient demonstrates adequate ability to tolerate and cope with physical discomfort. Mild to moderate signs or symptoms interfere with daily functioning.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 27

D. Risk rating 1

Question 28

For Dimension 2, rate the level of risk for the patient: The patient has come difficulty tolerating and coping with physical problems, and/or has other biomedical problems. These problems may interfere with recovery and mental health treatment. The patient neglects to care for serious biomedical problems.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 28

C. Risk rating 2

Question 29

For Dimension 3, rate the level of risk for the patient: Severe psychotic, mood, or personality disorder, which presents acute risk to patient. High risk and significant vulnerability for dangerous consequences. The patient exhibits severe and acute life-threatening symptoms.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 29

A. Risk rating 4

Question 30

For Dimension 3, rate the level of risk for the patient: Good impulse control and coping skills. Ability to focus on recovery, identify appropriate supports, and reach out for help. No emotional or behavioral problems, or problems identified are stable.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 30

E. Risk rating 0

Question 31

For Dimension 3, rate the level of risk for the patient: Adequate impulse control and coping skills to deal with any thoughts of harm to self or others. Emotional concerns relate to negative consequences and effects of addiction. Mild to moderate signs and symptoms with good response to treatment in the past.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 31

D. Risk rating 1

Question 32

For Dimension 3, rate the level of risk for the patient: Suicidal ideation; violent impulses; significant history of suicidal or violent behavior requires more than routine monitoring. Relationships or spheres of functioning are being impaired by substance use, but also are linked to a psychiatric disorder. Frequent and/or intensive symptoms with a history that indicates significant problems that are not well stabilized.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 32

C. Risk rating 2

Question 33

For Dimension 3, rate the level of risk for the patient: Frequent impulses to harm self or others, which are potentially destabilizing, but the patient is not imminently dangerous in a 24-hour setting. Insufficient or severe lack of capacity to cope with emotional or behavioral problems. Acute course of illness dominates the clinical presentation.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 33

B. Risk rating 3

Question 34

For Dimension 4, rate the level of risk for the patient: Patient is willing to enter treatment and explore strategies for changing his or her substance use and mental functioning, but is ambivalent for the need to change.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 34

D. Risk rating 1

Question 35

For Dimension 4, rate the level of risk for the patient: Patient is willingly engaged in treatment as a proactive, responsible participant and is committed to changing his or her alcohol, tobacco, other drug use, and/or mental functioning and behavior.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 35

E. Risk rating 0

Question 36

For Dimension 4, rate the level of risk for the patient: Patient is unable to follow through, has little or no awareness or mental disorder or substance use problems and any negative consequences, or, patient is unable to follow through with treatment recommendations, and as a result, his or her behavior represents an imminent danger of harm to self or others.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 36

A. Risk rating 4

Question 37

For Dimension 4, rate the level of risk for the patient: Patient exhibits inconsistent follow through and shows minimal awareness of his or her substance use disorder and/or mental disorder and need for treatment. Appears unaware of the need to change and thus is unwilling or only partially able to follow through with treatment recommendations.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 37

C. Risk rating 3

Question 38

For Dimension 4, rate the level of risk for the patient: Patient is reluctant to agree to treatment for substance use or mental disorder problems. Able to articulate negative consequences but has low commitment to change and/or to therapy.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 38

B. Risk rating 2

Question 39

For Dimension 5, rate the level of risk for the patient: Repeated treatment episodes have had little positive effect on the patient’s functioning. Has no skills to cope with and interrupt addiction or mental-health problems, or to prevent or limit relapse, OR, the patient has no skills to arrest the addictive disorder, or to prevent relapse to substance use or mental health problems.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 39

A. Risk rating 4

Question 40

For Dimension 5, rate the level of risk for the patient: The patient has little recognition and understanding of substance use relapse issues and mental illness relapse issues, and has poor skills to cope with and interrupt problems, or to avoid or limit relapse.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 40

B. Risk rating 3

Question 41

For Dimension 5, rate the level of risk for the patient: Patient has impaired recognition and understand of substance use relapse issues and mental illness relapse issues, but is able to self-manage with prompting.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 41

C. Risk rating 2

Question 42

For Dimension 5, rate the level of risk for the patient: Patient has no potential for further problems, or has low relapse potential and good coping skills.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 42

E. Risk rating 0

Question 43

For Dimension 5, rate the level of risk for the patient: Patient has minimal relapse potential, with some vulnerability, and has fair self-management and relapse prevention skills.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 43

D. Risk rating 1

Question 44

For Dimension 6, rate the level of risk for the patient: Patient has a supportive environment or is able to cope with poor supports.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 44

E. Risk rating 0

Question 45

For Dimension 6, rate the level of risk for the patient: Patient has passive support, or significant others are not interested in his or her recovery, but he or she is not too distracted by this situation and is able to cope.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 45

D. Risk rating 1

Question 46

For Dimension 6, rate the level of risk for the patient: Patient environment is not supportive and is chronically hostile and toxic to recovery or treatment progress. The patient is unable to cope with the negative effects of this environment on his or her recovery, OR, patient environment is not supportive and is actively hostile to addiction recovery, posing an immediate threat to the patient’s safety and well-being.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 46

A. Risk rating 4

Question 47

For Dimension 6, rate the level of risk for the patient: Patient’s environment is not supportive of recovery and he or she finds coping difficult, even with clinical structure.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 47

B. Risk rating 3

Question 48

For Dimension 6, rate the level of risk for the patient: Patient’s environment is not supportive of recovery, but, with clinical structure, the patient is able to cope most of the time.

A. Risk rating 4

B. Risk rating 3

C. Risk rating 2

D. Risk rating 1

E. Risk rating 0

Answer 48

C. Risk rating 2

Question 49

Level of care: 1, is described as:

A. 9 or more hours of service a week to treat multidimensional instability.

B. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

C. Less that 9 hours of service a week for recovery or motivational enhancement therapies and strategies.

D. Assessment and education for at-risk individuals who do not meet diagnostic criteria for substance use disorder.

Answer 49

C. Less that 9 hours of service a week for recovery or motivational enhancement therapies and strategies.

Question 50

Level of care: 2.1, is described as:

A. Less that 9 hours of service a week for recovery or motivational enhancement therapies and strategies.

B. 9 or more hours of service a week to treat multidimensional instability.

C. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

D. 24-hour structure with available trained personnel; at least 5 hours of clinical service a week.

Answer 50

B. 9 or more hours of service a week to treat multidimensional instability.

Question 51

Level of care: 2.5, is described as:

A. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

B. 9 or more hours of service a week to treat multidimensional instability.

C. 24-hour care with trained counselors to stabilize multidimensional imminent danger and prepare for outpatient treatment. Able to tolerate therapeutic environment.

D. Assessment and education for at-risk individuals who do not meet diagnostic criteria for substance use disorder.

Answer 51

A. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

Question 52

Level of care: 3.1, is described as:

A. 9 or more hours of service a week to treat multidimensional instability.

B. 24-hour structure with available trained personnel; at least 5 hours of clinical service a week.

C. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

D. 24-hour care with trained counselors to stabilize multidimensional imminent danger and prepare for outpatient treatment. Able to tolerate therapeutic environment.

Answer 52

B. 24-hour structure with available trained personnel; at least 5 hours of clinical service a week.

Question 53

Level of care: 3.3, is described as:

A. 24-hour nursing care and daily physician availability for significant problems. 16 hour a day counselor ability.

B. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

C. 24-hour care with trained counselors to stabilize multidimensional imminent danger and prepare for outpatient treatment. Able to tolerate therapeutic environment.

D. 24-hour care with trained counselors to stabilize multidimensional imminent danger. Less intense group treatment for those with cognitive or other impairments unable to use full therapeutic community.

Answer 53

D. 24-hour care with trained counselors to stabilize multidimensional imminent danger. Less intense group treatment for those with cognitive or other impairments unable to use full therapeutic community.

Question 54

Level of care: 3.5, is described as:

A. 24-hour care with trained counselors to stabilize multidimensional imminent danger. Less intense group treatment for those with cognitive or other impairments unable to use full therapeutic community.

B. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

C. 24-hour care with trained counselors to stabilize multidimensional imminent danger and prepare for outpatient treatment. Able to tolerate therapeutic environment.

D. 24-hour nursing care and daily physician availability for significant problems. 16 hour a day counselor ability.

Answer 54

C. 24-hour care with trained counselors to stabilize multidimensional imminent danger and prepare for outpatient treatment. Able to tolerate therapeutic environment.

Question 55

Level of care: 3.7, is described as:

A. 24-hour nursing care and daily physician availability for significant problems. 16 hour a day counselor ability.

B. 20 or more hours of services a week for multidimensional instability not requiring 24-hour care.

C. 24-hour care with trained counselors to stabilize multidimensional imminent danger. Less intense group treatment for those with cognitive or other impairments unable to use full therapeutic community.

D. 24-hour nursing care and daily physician care for severe, unstable problems in Dimensions 1, 2, or 3. Counseling available to engage patient in treatment.

Answer 55

A. 24-hour nursing care and daily physician availability for significant problems. 16 hour a day counselor ability.

Question 56

Level of care: 4, is described as:

A. 24-hour nursing care and daily physician care for severe, unstable problems in Dimensions 1, 2, or 3. Counseling available to engage patient in treatment.

B. 24-hour care with trained counselors to stabilize multidimensional imminent danger and prepare for outpatient treatment. Able to tolerate therapeutic environment.

C. 24-hour nursing care and daily physician availability for significant problems. 16 hour a day counselor ability.

D. 24-hour care with trained counselors to stabilize multidimensional imminent danger. Less intense group treatment for those with cognitive or other impairments unable to use full therapeutic community.

Answer 56

A. 24-hour nursing care and daily physician care for severe, unstable problems in Dimensions 1, 2, or 3. Counseling available to engage patient in treatment.