Crucial changes to substance use, co-occurring disorder care standards published

New edition of The ASAM Criteria® released
Learn About Hazelden Betty Ford

Rockville, Md. And Center City, Minn. (Oct. 5, 2023) – The first volume of the fourth and newest edition of the book of standards at the center of America's addiction treatment ecosystem is now available digitally—updated and enhanced to reflect current research and clinical best practices that facilitate better, patient-centered care and improve outcomes for the millions of people diagnosed with substance use disorders each year. Preorders of the print version are also now open.

First published in 1991 and last updated in 2013, The ASAM Criteria® promotes individualized and holistic treatment planning, and guides clinicians and care managers in making objective decisions about patient admission, continuing care, and movement along the continuum of care. It was first developed by the American Society of Addiction Medicine (ASAM) in partnership with a coalition of national and state organizations in the 1980s to define one national set of criteria for providing outcome-oriented and results-based care in the treatment of addiction. 

Published by the Hazelden Betty Ford Foundation, the first volume of the new fourth edition features an all-new digital subscription option with a searchable, reimagined e-reader, plus supplementary content for professionals and patients. The digital version of The ASAM Criteria increases access and ease of use for professionals to determine level of care, increase rates of care approval, and improve outcomes. 

The multimedia experiences support ongoing education and more widespread and consistent implementation: in addition, Hazelden Betty Ford will be one of the organizations ASAM partners with to offer training that helps workforces align so everyone in an organization uses the same edition in the same way for assessing and treating patients for better patient care.

"As the addiction treatment field has evolved considerably over the past decade, we had three major goals for this standards update: to reflect the latest research and clinical best practices; better support implementation of a chronic care model that promotes ongoing engagement in the treatment system and seamless transitions between levels of care; and making these standards as clear and simple as possible, within the context of a complex bio-psychosocial illness," said R. Corey Waller, MD, MS, DFASAM, editor in chief of The ASAM Criteria, Fourth Edition. "With Hazelden Publishing as a partner, the digital fourth edition makes it easier for people to utilize The ASAM Criteria and ultimately improve treatment outcomes and quality of life."

The standards in The ASAM Criteria help ensure that patients get objective evaluations and care recommendations and that service capabilities are consistent across treatment programs that provide a specific level of care. They are the foundation of substance use disorder treatment improvement efforts across the country and are especially significant given the U.S. is facing an unprecedented overdose and addiction crisis that began two decades ago and worsened during the COVID-19 pandemic. 

In addition to making updates related to research and best practices, ASAM and Hazelden Publishing focused on simplifying how information is presented and developing digital learning assets and multimedia content to support education and training. 

"The ASAM Criteria is the gold standard for ensuring patients get care appropriate to their individual needs and for helping patients and families understand their care recommendations—and the updates in the fourth edition will help advance the field on both of those important fronts," said Joseph Lee, MD, president and CEO of the Hazelden Betty Ford Foundation. "We know user-friendly design can be tricky, and that's where our Hazelden Betty Ford team comes in: by designing an intuitive digital interface with built-in multimedia learning content, we hope to increase adoption of The ASAM Criteria by clinicians nationwide. Our patient-centered supplementary content in the digital version of The ASAM Criteria is an exciting example of the new solutions Hazelden Betty Ford is developing to help more people find healing and hope and improve their quality of life."

New chapters in the fourth edition of The ASAM Criteria include:

  • Early Intervention and Secondary Prevention
  • Telehealth and Other Health Technologies
  • Integrating Recovery Support Services
  • Integrating Trauma-Sensitive Practices, Culturally Humble Care, and Social Determinants of Health
  • Addressing Pain
  • Addressing Cognitive Impairment

The updated continuum of care promotes: 

  • A CHRONIC CARE MODEL OF TREATMENT. The new 1.0 level of care provides ongoing monitoring for patients in stable remission, including ongoing medication management services for those prescribed addiction medications. 
  • INTEGRATION OF CARE. The fourth edition integrates withdrawal management and biomedical services into the continuum of care alongside psychosocial services.
  • CO-OCCURRING CARE. The fourth edition promotes more integrated care for co-occurring mental health conditions by incorporating standards for "co-occurring capable care" into the core standards for all levels of care. 
  • ACCESS TO RECOVERY SUPPORT SERVICES. The fourth edition advocates for recovery-oriented systems of care by including standards for recovery support services to be available directly or through partnerships at each level of care and to promote ongoing remission monitoring and recovery management checkups for patients who have achieved sustained remission. ASAM collaborated with the National Alliance for Recovery Residences to also define criteria for recommending recovery housing in addition to an outpatient level of care.
  • HARM REDUCTION. The fourth edition encourages clinicians to consider harm reduction-related needs for each patient, emphasizing the importance of engaging with patients to understand and be responsive to their treatment goals and preferences. It also incorporates low-threshold addiction medication access.

The fourth edition of The ASAM Criteria will be released in four volumes. Subsequent volumes will focus on adolescents and transition-age youth, justice-involved patients, and treatment of behavioral addictions (i.e., gambling, internet, and gaming addiction). Hazelden Betty Ford will host a webinar Oct. 25, featuring ASAM board member and Hazelden Betty Ford Chief Medical Officer Alta DeRoo, MD, FASAM, and Maureen Boyle, PhD, chief of ASAM Quality and Science, to discuss to key changes in the fourth edition and why those changes are crucial for innovative person-centered care. 

About the American Society of Addiction Medicine   

The American Society of Addiction Medicine (ASAM), founded in 1954, is a professional medical society representing over 7,500 physicians, clinicians, and associated professionals in the field of addiction medicine. ASAM is dedicated to increasing access and improving the quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addiction. For more information, visit


About the Hazelden Betty Ford Foundation

The Hazelden Betty Ford Foundation is a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs. As the nation's leading nonprofit provider of comprehensive inpatient and outpatient addiction and mental health care for adults and youth, the Foundation has treatment centers and telehealth services nationwide as well as a network of collaborators throughout health care. Through charitable support and a commitment to innovation, the Foundation is able to continually enhance care, research, programs and services, and help more people. With a legacy that began in 1949 and includes the 1982 founding of the Betty Ford Center, the Foundation today is committed to diversity, equity and inclusion in its services and throughout the organization, which also encompasses a graduate school of addiction studies, a publishing division, an addiction research center, recovery advocacy and thought leadership, professional and medical education programs, school-based prevention resources and a specialized program for children who grow up in families with addiction.