Sensitivity of the ASAM Criteria to Psychiatric Need
Walter M. Drymalski
Michael R. Nunley
Published online: 14 September 2017
Springer Science+Business Media, LLC 2017
Abstract The ASAM Criteria (ASAM) is one of the most widely used placement tools in the
addiction field. Its use, however, has focused on placement of individuals into addiction-only
or co-occurring addiction and mental health services, not individuals who need primary mental
health treatment. This study examined whether the ASAM, particularly dimension 3 (D3), was
sensitive to mental health needs of a group of individuals placed into addiction services using
the ASAM then followed for 1 year to determine whether they received mental health services.
Individuals who received mental health services had D3 scores that were twice as high as those
who did not, and individuals with a BPsychotic Disorder^ had higher scores than all other
diagnostic clusters. At a cutoff of 1, D3 had a sensitivity of .89 and specificity of .44 (C =.73).
These results argue for an expanded application of the ASAM across the behavioral health
National prevalence of mental health disorders among individuals with substance use disorders
(SUDs) suggests high rates of comorbidity. For example, in the 2014 National Survey of Drug
Use and Health, it was estimated that nearly 40% (39.1%; 7.9 million of 20.2 million
individuals) of all adults with a past year SUD had a co-occurring mental health disorder,
compared to 16.2% of adults without a past year SUD (Center for Behavioral Health Statistics
and Quality 2015). Moreover, among these individuals with a past year SUD and co-occurring
mental illness, over 11% (2.3 million) had a serious mental illness (Center for Behavioral
Health Statistics and Quality 2015).
The high incidence of co-occurring SUD and mental health disorders argues for the use of
screening and assessment instruments that can effectively identify individuals presenting for
SUD treatment who might also have mental health issues that warrant further attention and/or
intervention (Substance Abuse and Mental Health Services Administration [SAMHSA] 2005).
Int J Ment Health Addiction (2018) 16:617–629
* Walter M. Drymalski
Milwaukee County Behavioral Health Division, Community Access to Recovery Services, 9201
Watertown Plank Road, Milwaukee, WI 53226, USA