Dr. Miller: As Managing Editor and as a member of a workgroup for the ASAM PPC-2, I have great interest in this project historically and in making the new ASAM criteria the best it could be.
To learn more about the new edition of The ASAM Criteria, visit www.ASAMcriteria.org, where you will find helpful resources, such as videos with Dr. David Mee-Lee, news articles, FAQs, a slide deck download and upcoming events.
Dr. Miller: I reviewed many sections and contributed to several: Tobacco Use Disorder, Older Adults, Persons in Safety-Sensitive Occupations and aligning The ASAM Criteria with ASAM's definition of addiction.
Terminology is quite challenging in our field, and we need to acknowledge that and do the best we can in a world with many stakeholders and viewpoints. Assessment should examine addiction in all its manifestations.
Michael M. Miller, MD, FASAM
Herrington Recovery Center, Rogers Memorial Hospital
The ASAM Criteria
Why did you decide to play such an integral role in creating this new edition?
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David Mee-Lee, MD
Senior Vice President
The Change Companies®
The ASAM Criteria
What were some specific sections you were drawn to updating?
Can you speak to the process of writing and editing The ASAM Criteria? How did you collaborate with other experts, committee members, editors and/or field review responders?
Dr. Miller: As Managing Editor, I spoke with all the chapter authors and worked closely with Dr. Mee-Lee. The exchange of ideas was excellent.
Dr. Mee-Lee: The final text of The ASAM Criteria passed through many layers of review. Expert authors and workgroup chairs incorporated current research and practice into drafts developed in collaboration with committee members. Then we hosted a broad stakeholder field review that provided valuable suggested changes, modifications and new information that the workgroups considered and incorporated as necessary. The Managing and Deputy Editors and I reviewed the final drafts and made further changes or clarifications. Then the careful and painstakingly detailed process of the Publication Editor and the proofreading team at The Change Companies® scoured the drafts for errors, but also read the text through the eyes of a new reader unfamiliar with ASAM’s criteria.
This objective perspective enhanced the readability and relevance of the final text and highlighted sections that needed further explanation through the use of graphics, color and layout presentation.
What are the key messages you hope readers grasp from this edition?
Dr. Miller: The original concepts of ASAM's criteria remain relevant: the intensity of service should derive from the severity of illness, and the condition requires comprehensive assessment along 6 dimensions of illness. Other concepts, such as the fact that medications can be important in addiction treatment, and that it is important to address addiction involving nicotine, are also key features of the new edition.
A major advance in The ASAM Criteria (2013) is the vision shown in making clear that addiction involving tobacco and nicotine should be treated as any other addiction, along with addiction involving other substances, and not ignored or addressed "later."
Dr. Mee-Lee: While the use of The ASAM Criteria has been and continues to be for decisions about what level of care can best meet patients’ needs, this edition stresses much more. The book helps guide the addiction and mental health field in how to better integrate addiction identification, assessment and treatment into mental and general health care settings where most addiction patients are presenting for healthcare and help.
As you look to the future, how do you see The ASAM Criteria impacting the field of addiction treatment?
Dr. Miller: Addiction treatment will continue to evolve, with more addiction care being delivered in less intensive general medical settings (including primary care). The ASAM Criteria provides a framework for patient assessment and reassessment as well as evaluation of patient status during chronic disease management.
Dr. Mee-Lee: From the very first edition in 1991, ASAM's criteria has always had a goal to increase access to care for people needing addiction services. With this new edition released in the era of healthcare reform, The ASAM Criteria provides guidance to broaden that access to care for people in mental health and general health care settings. By applying the principles, concepts and criteria of The ASAM Criteria, clinicians, counselors, funders and care managers are encouraged to use scarce resources efficiently and effectively, so patients can access all the care they need for successful recovery.
[In the criteria,] we recognize addiction as a biopsychosocial condition that involves the pathological pursuit of reward and/or relief through the use of substances or the engagement in addictive behaviors, including gambling. We [also made the decision to] incorporate new ASAM definitions of recovery, relapse, abstinence, sobriety, craving, harm reduction and medication assisted recovery.
Working in the area of physician health as I do, the section on persons in safety-sensitive occupations, specifically, does a wonderful job of pointing to the special treatment needs of these individuals, not just physicians and not even solely health professionals.