In 1991, ASAM debuted perhaps one of the most significant documents regarding best-care practices in addiction medicine offered at that time: the Patient Placement Criteria (ASAM Criteria). The ASAM Criteria represented ASAM’s commitment to individualized patient care and it mirrored an industry trend away from inpatient or residential programs as the only method of treatment. During this time, ASAM eagerly engaged in federal advocacy around many subjects but focused on achieving “parity” in third-party insurer coverage, with the goal of ending discriminatory exclusions for addiction medicine treatment. The effort reflected ASAM’s long-held commitment to viewing—and treating—addiction as a medical disease rather than a social or moral failing. Legislative advocacy required extensive coalition-building.

During this time, ASAM cemented its role within larger medical organizations—for example, maintaining its strong relations with the American Medical Association (AMA) House of Delegates. ASAM also affirmed and strengthened partnerships with executive branch departments, agencies, and institutes, and increasingly with legislative offices. ASAM partnered with national agencies such as NIAAA, NIDA, and the Substance Abuse and Mental Health Services Administration (SAMHSA). In 1993, ASAM became involved with health care reform efforts initiated under President Bill Clinton, recognizing the opportunity to prioritize addiction treatment. Parity, however, would not be enshrined in law until 2008, and it took a frustrating several years for the law to be implemented via the adoption of administrative rules in the code of federal regulations.

In the 1990s, the scientific community and the American public alike began to fully recognize the dangers inherent in using tobacco products and nicotine. In response, federal regulators and state governments scrutinized the ingredients cigarette manufacturers used in their products and how and to whom they marketed their products, and pharmaceutical researchers developed new treatment options for persons trying to quit smoking. ASAM leaned into these debates and found a way to guide the conversation and offer its expertise to legislative leaders, especially through partnerships with federal agencies such as NIAAA and NIDA. Additionally, a number of ASAM members served in official capacities with medical, professional, and governmental organizations such as the AMA, SAMHSA, and SAMHSA’s Center for Substance Abuse Treatment. ASAM members and staff met with members of Congress on key issues and encouraged letter-writing campaigns to senators and representatives. Leveraging the vast experience of its members and decades of institutional experience, ASAM positioned itself to be a national authority on the most pressing addiction medicine issues. In parallel with concern over smoking, decriminalization, and legalization of cannabis also became part of national conversations. ASAM members did not universally agree, however, on issues related to cannabis use, decriminalization, and legalization, a debate that remains relevant and active today.