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The Addiction Severity Index (ASI) is one of the most widely used tools for the assessment of
substance use-related problems. Clinicians all over the world use the ASI to get a better understand-
ing of their clients treatment needs and outcomes.
One of the things that distinguishes the ASI from most other addictions assessment tools is its focus
on the big picture. Instead of just considering the clients substance use, the ASI also aims its
spotlight on the individuals medical, employment, legal, family, social and psychiatric status. This
wide angle view is designed to help you--and your client--get a better understanding not just of the substance
use, but also other problems that affect the client and his or her recovery.
While many people use the ASI as an instrument for monitoring progress and outcomes, it can also be
used to develop treatment plans. The purpose of this manual is to help you develop effective treat-
ment plans using the ASI. Afterall, when an ASI is done well, it contains a substantial amount of
valuable information. It is our hope that better treatment plans will lead to higher rates of recovery and
better overall treatment outcomes.
Addiction Severity Index (ASI)
Treatment Planning Manual
Table of Contents
Introduction 2
Organization of Manual 2
Treatment Philosophy 2
Address Client Needs 2
Affirmative Focus 3
Regulatory Requirements 3
Using the ASI to Develop the Treatment Care Plan 3
Principle #1 Utilize Client Ratings 3
Principle #2 Addressing Client Problems 4
Principle #3 Balancing Treatment Priorities 4
Key ASI Items for Treatment Care Planning 4
General Information 4
Medical Section 4
Employment/Support Section 5
Drug/Alcohol Section 5
Legal Status 5
Family/Social Section 5
Psychiatric Section 6
Meet Mary 7
Marys Medical Status 8
Marys Employment/Support Status 9
Marys Drug and Alcohol Use 10
Marys Legal Status 11
Family History 12
Marys Family/Social Relationships 13
Marys Psychiatric Status 14
Master Problem List 15
Marys Medical Care Plan 16
Marys Support System Care Plan 17
Marys Addiction Care Plan 18
The Treatment Planning Process 19
Addiction Severity Index (ASI) 2
Treatment Planning Manual
The Organization of this first consider treatment philoso- treatment process. Specifically,
Manual phy. This manual incorporates when a client chooses health and
two fundamental principles which moves in the direction of recov-
The manual begins by examin- guide the treatment planning ery, the counselor should affirm,
ing, Marys completed ASI. We process. These principles are: support and praise the client in a
have attempted to highlight key Address Client Needs and variety of ways (for example,
elements in each problem area, Affirmative Care. verbal recognition, graduation
and to indicate the significance ceremonies, award cerficates,
of each element for treatment Address Client Needs etc.).
planning.
The first treatment planning On the other hand, when a client
Following the examination of the principle is that clients will do chooses to move in a direction
actual ASI, a Master Problem best when there is a comprehen- that is self-destructive (that is,
List is presented. This is an sive effort to address their needs. noncompliant with treatment
important step in the treatment By recognizing and addressing goals) the counselor should work
planning process because it pulls the clients needs in a variety of to maintain contact with the
together on one page all of the domains (e.g. medical, legal, client, and search for some
problems that the client presents. psychiatric, etc.) treatment aspect of the clients behavior or
programs demonstrate to the actions that can be praised or
Next there is a presentation of client that they acknowledge their given positive recognition.
Marys treatment plan along with clients concerns and are inter-
some commentary as to why ested in working with the client In some cases, the counselor
certain action steps were se- towards solutions. needs to make a special effort at
lected and other delayed. In finding something to praise. For
addition, we have included a In addition, when a client tells us example, when a client reports a
description of how our imaginary about specific issues that they relapse, the counselor should
client responded. perceive as obstacles to their lavishly praise the fact that the
recovery, we can create a power- client successfully interrupted
Following the case presentation ful alliance by joining them in the relapse and returned to
there is a brief section that working to improve their total treatment! The counselor might
covers some of the technical situation. Of course, the purpose also acknowledge the client for
aspects of treatment planning. of all this collaboration is not just his or her honesty, courage and
You may feel free to go right to for the sake of establishing commitment to recover.
this section first if you are rela- rapport. Ultimately, research has
tively new to treatment planning shown that by directly addressing Naturally, it is important that we
and want to get some technical client needs, programs and remain authentic when we praise
assistance. Even if you are an counselors will be more effective a client. If our comments come
experienced counselor, you in assisting their clients in pro- off as phony or insincere, our
might still find this section useful gressing towards a lasting recov- whole credibility can be compro-
because it demonstrates how ery. mised. However, if we honestly
ASI data can be used to develop consider the challenges that our
treatment plans. Affirmative Focus clients face, we usually will come
to the conclusion that their gains
Treatment Philosophy Our second treatment principle are in fact extraordinary and
Before we consider Marys case, recognizes the benefits of praise more than worthy of our compli-
it might be a good idea for us to and acknowledgement in the ments and recognition.
Addiction Severity Index (ASI) 3
Treatment Planning Manual
problems, acknowledging them Key ASI Items for have a chronic pain problem that
with the client and discussing Treatment Care Planning will need to be evaluated? Is the
potential strategies for dealing client currently receiving services
with them are important to the The ASI is designed to assess for a medical problem? If so, is
recovery effort - even when your client status in many different the client satisfied with the
agency does not have on-site areas of life functioning. The treatment? Is further assessment
services for those problems. You following ASI items are important indicated? What level of distress
may need to offer a client a to consider when you are devel- is reported (M7) and how impor-
referral for additional, out-of- oping a treatment care plan: tant is it to the client to receive
program services. treatment services (M8)?
General Information
Balancing Treatment Employment /Support
Priorities Demographic data reported in Section
this section may provide impor-
No single problem area is always tant information early on that will Does the client have a high
the most important or the one be relevant to treatment care school education, GED, or
that should be treated first. planning. Does the client report marketable trade or skill (E1-3)?
Concurrent treatment of multiple gender (G10) or cultural (G17) Items E4/5 are important consid-
problems is generally better than issues that may affect participa- erations if the client does not
sequential treatment. tion in treatment? Does the have access to public transporta-
Addiction occurs in the context of clients age (G16) present special tion for employment or if the
other problems that may either considerations, i.e., medical, client is seeking employment that
contribute to or result from employment or housing prob- requires driving.
substance abuse. You will rarely lems? If the client reports hospi-
be able to identify causal rela- talization, incarceration, psychiat- Look at the clients work history
tionships between problem areas ric or substance abuse treatment (E6/7) and usual employment for
and it is important not to assume in the past 30 days (G19/20), are the past 3 years (E10). Has the
that any single problem is the follow-up services indicated? client ever been able to maintain
key to resolving all other prob- a period of steady employment?
lems. Medical Section Is the client currently employed?
If not, how long has he/she been
You have to start somewhere and Does the client report chronic out of the job market?
it is not always easy to prioritize medical problems (M3) that
treatment goals. You may need require ongoing care or daily Items E8/9 are an indication of
to defer goals in some areas until monitoring, such as asthma, the clients current ability to
the patient is stabilized or till you diabetes, high blood pressure? maintain self-sufficiency. Does
can get a referral for additional Has the client been prescribed the client have a family to sup-
out-of-program services. While medication (M4) on a regular port (E18)? What has been the
the initial treatment plan may basis for a medical problem? Is clients source of income in the
focus on reducing substance use the medication taken as pre- past 30 days (E12-17)?
first, the master treatment plan scribed? Does the medication
should address all problem areas prescribed need to be re-evalu- You will want to look at item E19.
for which treatment is indicated. ated by a physician? How many If unemployed, has the client
days (M6) has the client experi- actively looked for work in the
Now, as you read this manual, enced physical medical problems past 30 days? If employed, is
you will see how we use the ASI and what symptoms have they the clients job in jeopardy? How
to design treatment plans. experienced? Does the client important is it to the client to get
Addiction Severity Index (ASI) 5
Treatment Planning Manual
help with employment problems ment? Look at the clients crimi- threatening situation (F28/29, F30/
(E21)? nal history (L3-17). If an exten- 31)? Have there been any serious
sive legal history is reported, are family or social conflicts in the past
Drug/Alcohol Section there issues, attitudes or behav- 30 days (F30/31)? How important
iors that you will want to address is it to the client to receive treat-
Items D1-14 tell you about the as part of treatment? ment for family/social problems
clients substance abuse history (F34/35)?
and current drug/alcohol use. Are there any pending legal
Has the client ever been able to charges (L3-16, L18-20)? Is the Psychiatric Section
maintain a month or more of client awaiting charges, trial or Has the client ever received
abstinence and, if so, how long sentence (L24-26)? Has the professional treatment for psycho-
has it been since the last period client reported engaging in days logical or emotional problems (P1/
of abstinence (D15/16)? of illegal activity in the past 30 2)? Is follow-up treatment recom-
days (L27)? Look at the client mended? If the client reports an
Look at indicators of the severity ratings (L28-29). Does the client extensive treatment history (P1/2)
of the addiction, such as over- indicate a need for legal services or receives a pension for a psychi-
doses (D17), delirium tremens for current legal problems? atric disability (P3), you will want to
(D18), and treatment history pay particular attention to past 30-
(D19-22, D25). How much Family/Social Section day symptoms (P4-10). Does the
money is the client actually client need to be referred for a
spending for alcohol/drugs (D23/ Look carefully at the clients psychological evaluation? Has the
24)? How many days has the marital status, usual living ar- client been prescribed medication
client experienced problems rangements, and use of free time for a psychological problem (P4)?
related to substance abuse (D26/ (F1-6, F9/10)? Is the client Is the medication taken as pre-
27)? satisfied with current status in scribed? Does the medication
theses areas or merely resigned prescribed need to be re-evaluated
How does the client assess his/ to his or her situation? Does the by a physician? How many days
her level of distress or desire for client report stable living arrange- (P12) has the client experienced
treatment for substance abuse ments or is there a need for psychological medical problems?
problems (D28-31)? If a signifi- referral for housing? Does the client report a significant
cant history and current sub- level of distress or desire for
stance abuse problems are Consider problems like loneli- treatment for psychological prob-
reported and client ratings (D28- ness, social isolation, and the lems (P13/14)? Carefully consider
31) are low, denial may be need for a sober support network the interviewers clinical impres-
indicated. (F9-11). Is the home environ- sions (P15-20).
ment supportive of recovery (F7/
Legal Status 8)? Has the client ever been
able to maintain a close mutual
Items L1/2 tell you something relationship with others (F12-17)?
about the relationship between Look at items F18-26. Does the
the clients legal status and the client report a history of lifetime or
clients treatment status. Is the current serious relationship prob-
client court stipulated to treat- lems? How might these problems
ment or currently on probation or impact on treatment? Are past or
parole? Will the client suffer current abuse issues reported that
legal consequences as a result may undermine recovery efforts
of noncompliance with treat- (F27-29)? Is the client in a life-
Addiction Severity Index (ASI) 6
Treatment Planning Manual
Medical Status
Employment/Support Status
Chronically Unemployed...Sort of
E1 E2 and E3 reveal that Mary
lacks technical and professional
skills.
With items E4 and E5 her
situation gets a little worse--she
doesnt drive either so she is
dependent upon public transpor-
tation.
Figure 3
In fact, Mary has been unemployed
E10 for at least the past three years.
Figure 3
Arrest History
Looking at L29, we discover that sex for money, security or protec- compliance may become a new
Mary is highly motivated to deal tion. When we get to the Family habit and the beginning of a new
with her legal problems even section of the ASI, we will want life.
though she doesnt think theyre to explore this aspect of her life
very serious. What do you to determine whether there is a Our challenge will be to use
suppose this means? history of sexual abuse. Marys legal difficulties as lever-
age in gaining her compliance,
Perhaps Mary wants to get her Summing Up while at the same time maintain-
probation officer off her back ing a positive, therapeutic rela-
but doesnt think that she did We see from L1 that Marys got tionship with her. To do this, it
anything that was too serious. Is a probation officer who thinks may be important to work closely
this an aspect of her denial, or shes got a drug problem and with her probation officer. Con-
simply defiance? We will need to that she needs help. Thats the sequently, we will want to get a
help her think through the seri- good news. The bad news is consent from Mary so that you
ousness of her legal problems that Mary disagrees. can interact with her probation
and risks. officer.
Nonetheless, because her
Prostitution probation officer is forcing her
into treatment, Mary is willing to
Typically, someone else--perhaps comply, if only minimally. If we
quite early in her life--introduced can work with her in designing an
Mary to the idea of exchanging attractive treatment plan, her
Addiction Severity Index (ASI) 11
Treatment Planning Manual
Family History
Moms Side
Family/Social Relationships
In addition, given Marys involve- Mary wants to have better social section: Psychiatric Status. Lets
ment in prostitution, the fact that and family relations (F34 and F35). see what it tells us about Marys
she reports being sexually abused Consequently, her treatment plan treatment needs.
earlier in her life takes on special will need to provide her with guid-
meaning; we will want to address ance in addressing this important
this in individual counseling. need.
Summing Up Before we begin developing a
Mary clearly wants help in deal- treatment plan with Mary, weve
ing with her current family and got one more important ASI
social relations.
Addiction Severity Index (ASI) 13
Treatment Planning Manual
Psychiatric Status
Untreated Depression
Medical Care
Follow-up
Support System
Marys Choice
Addiction Treatment
Dual Capabilities
After a rocky start, Mary eventu- Her anxiety disappeared once she In the meantime, she would
ally became stabilized on 60 began treatment. She was pre- remain in counseling and con-
milligrams of methadone. She scribed an antidepressant, but tinue her participation in Narcot-
has been coming to the clinic on once again, Mary elected not to ics Anonymous and Alcoholics
a regular basis for about a month take it. She indicated that she Anonymous, which she had
now, and she has significantly preferred to see how she was begun attending with some of the
reduced her use of all other illicit doing after a month or so off the other women in the recovery
substances. streets and in her new life. Mary house.
agreed that if, after a couple
Mary was seen by our psychia- months, she wasnt feeling better,
trist who diagnosed her as she would be willing to reconsider
having PTSD and depression. her decision.
Addiction Severity Index (ASI) 18
Treatment Planning Manual
The Treatment Planning organizations, one person single- All of this information, when
Process handedly collects all the informa- available, should be considered
tion that constitutes the assess- by the treatment team prior to
Treatment planning is a collabo- ment. In either case, a good beginning the treatment planning
rative process in which a team of treatment plan incorporates process.
professionals and the client information from all possible
develop a written document that: sources. Preliminary vs. Master Treat-
ment Plans
a. identifies the clients most Many of us work in settings
important treatment goals where there are only one or two Many programs develop an
professional disciplines repre- initial, or preliminary treatment
b. describes measurable, time- sented (such as counselors and plan, usually within the first 24
sensitive steps towards achieving a physician). For example, the hours after a client has been
those goals treatment team may include a admitted. This is a requirement
physician and several counse- of the JCAHO as well as many
Lets break this process down to lors. It has been our experience States. A preliminary treatment
its component parts. that the best treatment plans are plan is designed to get the
developed when the client and a treatment process started even
Collaborative Assessment multi-disciplinary clinical team before a comprehensive assess-
Process work together in a collaborative ment has been completed.
process, sharing ideas and Preliminary treatment plans need
One of the first things that hap- solutions. to be followed by a comprehen-
pens to our clients when they sive treatment plan within a
enter treatment is that members Sources of Assessment matter of days (on an inpatient
of a treatment team begin asking Information unit) or couple weeks (in an
lots of questions. Some of these outpatient service).
questions are purely administra- There are a wide range of pos-
tive in nature (e.g. what type of sible sources of information all of Preliminary treatment plans
insurance do you have) and which may contribute to the identify services that are to be
others are more clinical in nature assessment process. Some of provided and the time frames for
(e.g. when did you have your these information sources in- achieving specific critical tasks
last drink). All of these ques- clude, but are not limited to: such as the completion of the
tions contribute to the assess- comprehensive assessment.
ment process, and as such, Intake Interview Preliminary treatment plans, by
should be considered during the ASI their very nature, have a limited
treatment planning process. Psychosocial History degree of individualization be-
Family & Friends Interview cause the assessment process
In many organizations people Medical Assessment has not yet been implemented.
with varying credentials collect Psychiatric Assessment Nonetheless, whatever informa-
information from the client. A Nursing Assessment tion is available should be care-
clerk may obtain demographic Laboratory Studies (e.g. drug fully considered when developing
and insurance information, a screen) a preliminary treatment plan.
nurse may obtain medical infor- Probation Officer Report
mation and a counselor may Police Report (if client was For example, if our intake inter-
complete an ASI and interview referred by criminal justice view revealed that an outpatient
the clients family. In other system) client was living in a situation
EAP Referral Information
Addiction Severity Index (ASI) 19
Treatment Planning Manual
where drugs were freely available together all of the available data into the essential, critical
or with other active drug addicts, assessment information into one elements.
we would want to immediately integrated interpretation of the
begin working with the client to clients current status. A good Upon completing this thoughtful
find alternative housing. If we diagnostic summary attempts to process, the counselor is ready
delay this particular intervention paint a clear picture of the clients to move forward and begin
too long, there is a significant risk personal history, strengths and developing a treatment plan.
that the client may not remain in challenges. Areas covered in a
treatment long enough to com- diagnostic summary might in- Writing a Treatment Plan
plete a comprehensive assess- clude, but not be limited to:
ment! Problem Summary
Mental Status
Master Problem List Possible Mental Disorders A treatment plan typically begins
Risk Assessments with a Problem Summary (see
Throughout the accumulation of Treatment History our sample Treatment Plan
all assessment information, the Reasons for Treatment Form). The Problem Summary
clinical staff should add items to Physical Health & Nutrition pulls items from the Master
the clients Master Problem List. Substance Use History Problem List and whenever
Once again, this should be a Obstacles to Recovery possible combines related prob-
collaborative process with all Work History lems.
members of the clinical staff Family History
contributing from their profes- Sexuality & Intimate Relations For example, in Marys case, our
sional perspectives. A sample Beliefs and Values Master Problem List included the
Master Problem List Form is Education History following items (see page 13):
attached. Finances History
Military History Needs medical exam
Quite simply, any problem or area Legal Problems Needs medications evaluated
of concern for the client or clinical Freetime Pain status needs to be as-
team should be placed on the Special Issues sessed
Master Problem List. This list Assets
should be updated periodically Liabilities Marys Problem Summary com-
with items dropped as they are Readiness to Learn bined these items into the follow-
resolved and others added as the ing statements:
clinical team becomes aware of When a diagnostic summary is
them. properly written, other clinicians Mary has medical concerns
should be able to get a decent including chronic pain. Mary
Diagnostic Summary understanding of the client from it. needs to have her current medi-
cations evaluated.
Many states, as well as the One of the benefits of writing a
JCAHO, require that addiction diagnostic summary is that the Goal
treatment and mental health author is forced to think about the
programs complete a Diagnostic client in order to develop an The next element of a treatment
Summary prior to developing a interpretation of all the assess- plan is the creation of a treatment
comprehensive treatment plan. ment information. The individual goal. A goal describes the desired
The diagnostic summary pulls writing the diagnostic summary
not only reviews all of the as-
sessment information, but also
attempts to boil down all of this
Addiction Severity Index (ASI) 20
Treatment Planning Manual