Updated ASAM Criteria, Fourth Edition: A timely cue to assess addiction treatment risks

By Justin Sanches, Underwriting Manager - Miscellaneous Medical & Life Sciences and Paige Castillo, Underwriter - Miscellaneous Medical & Life Sciences 

The American Society of Addiction Medicine (ASAM) recently unveiled the fourth edition of the ASAM Criteria, featuring the latest updates to industry standard guidelines for determining the appropriate placement, ongoing care, transition, or discharge of individuals suffering from addiction and concurrent disorders.  

How the ASAM Criteria impacts healthcare facilities and insurance producers  

The variety of treatments for drug and alcohol addiction present distinct challenges for both patients and providers.  The ASAM Criteria is among the most extensively adopted and comprehensive guidelines on the topic¹. Accordingly, the launch of the updated edition offers an opportune moment for US-based drug and alcohol treatment companies and the insurance producers placing liability insurance on their behalf to review and update their practices to effectively manage these evolving risks.  

Healthcare professionals offering addiction treatment at all levels of the care continuum, from early intervention and outpatient services through intensive inpatient treatment facilities, have the potential to be impacted by the updated criteria. Typical risks for these facilities include medication management, sexual misconduct, suicide, and overdose. Since the last edition of the ASAM Criteria was released in 2013, some risks have become more prevalent, and the updates help identify these risks.  

The evolution of addiction treatment 

In the past decade, the addiction treatment field has evolved remarkably. The updated edition of the ASAM Criteria mirrors these advancements by advocating for a more holistic approach to care. This approach emphasizes sustained engagement in treatment and seamless transitions across the various levels of care, ensuring a more integrated and comprehensive treatment experience. Providers in the drug and alcohol addiction care sector should familiarize themselves with these updates, as well as with the newly refined definitions for various levels of care, treatments, and services, as any of these changes could increase the standard of care for this vulnerable population.  

Addressing key risk factors 

In conjunction with a review of the updated ASAM Criteria, providers should conduct a thorough evaluation of how they currently address key risk factors. Training programs should also be reviewed to ensure that they appropriately equip staff with skills suitable for specific care levels. Additionally, as maintaining appropriate staff-to-client ratios is crucial, providers should ensure that they remain compliant with regard to the updated criteria. 

Providers should also ask themselves critical questions to manage other key risk factors effectively. These include: Are we diligently monitoring for any indications of sexual abuse among patients, considering gender separation strategies? Is our medication management oversight sufficiently robust? How often are we conducting bed checks, especially for patients in detoxification? Because application of the ASAM Criteria may vary by state, it's important to review your state's specific guidelines for alcohol and addiction care. 

Beazley can help if you need additional support 

For providers unsure about adherence with ASAM’s updated criteria, Beazley offers support from our partner OmniSure, often at no additional cost to policyholders. OmniSure is an independent risk management consulting firm specializing in the issues, requirements, standards, levels of care, and unique patient populations specific to the drug and alcohol addiction care sector. Resources including in-depth risk management assessments, tailored recommendations, and a helpline for general inquiries are all available to insureds depending on policy terms. As Beazley partners, brokers are also welcome to use these tools to better serve their clients in the drug and alcohol addiction space. To learn more, visit www.riskfitness.com/beazley-helpline.