American Society of Addiciton Medicine
Jul 10, 2023 Reporting from Rockville, MD
Frequently Asked Questions
Jul 10, 2023

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American Society of Addictin Medicine


Frequently Asked Questions

What is ASAM CONTINUUM and CO-Triage?

The ASAM CONTINUUM is a validated, computer guided ASAM Criteria assessment software for individuals with substance use disorders and co-occurring conditions. Through a structured interview, CONTINUUM conducts a comprehensive biopsychosocial patient risk and treatment needs assessment to accurately determine the least intensive, but safe and appropriate level of care recommendation and generate comprehensive patient reports for treatment planning and utilization review. The software is based on the ASAM Criteria and uses research-quality questions, including the ASI, CIWA, and CINA instruments.

The ASAM Criteria is the most widely used and comprehensive text of guidelines for treating patients with substance use disorders. ASAM’s CONTINUUM is a software which guides clinicians through a standardized ASAM Criteria assessment and assists them with determining the least intensive, but safe and appropriate level of care placement. ASAM’s CONTINUUM and the ASAM Criteria should be used in tandem—the text provides background and guidance for proper use of the software, and the software enables comprehensive, standardized evaluation. With CONTINUUM, clinicians can easily conduct a comprehensive biopsychosocial patient risk and needs assessment along all six ASAM Criteria Dimensions while determining The ASAM Criteria Levels of Care recommendation. .

The ASAM CO-Triage (CONTINUUM Triage) is a brief referral tool for patients with substance use problems. CO-Triage broadly assesses treatment needs for substance use problems across each ASAM Criteria dimension to generate and direct patients to a provisionally recommended level of care placement where they can receive a comprehensive ASAM Criteria assessment. The tool is designed for clinical and non-clinical settings and can be used by providers who are non-specialists in addiction medicine (e.g., social workers, etc.). CO-Triage can be administered in person or over the phone, and all questions can be imported into a CONTINUUM assessment.

Both are clinical decision support tools that assess individuals with substance use disorders and co-occurring conditions and can identify ASAM dimensional needs that require immediate medical attention including any withdrawal, co-occurring, or bio-medically enhanced conditions. Co-Triage is a brief, provisional assessment that generates an initial level of care placement recommendation where the patient may receive a comprehensive assessment. CONTINUUM is a comprehensive biopsychosocial assessment that generates two thorough patient reports that detail DSM-5TR substance use disorder diagnoses, severity, and imminent risks as well as a recommended level of care determination. Please visit the CONTINUUM product page to learn which tool is best for you..

Multiple controlled studies were conducted with the earlier versions of the ASAM Criteria Software on which ASAM’s CONTINUUM is based. Alpha testing was done for three years in ten centers across Norway. Beta testing was conducted in Milwaukee County in their Central Intake Centers. The National Demonstration Project tested the software for six months in real-world, routine clinical practice with twenty systems across the US. Please reference our CONTINUUM Research page for more information.

The ASAM CONTINUUM is currently only available in English. The ASAM CONTINUUM platform has been programmed such that it can be readily translated into other languages. In fact, ASAM’s CONTINUUM was successfully tested in Norway and translations have been made into French and Norwegian. ASAM, the CONTINUUM developer, will be conducting surveys to determine what languages it will be translated into. To request a specific translation, please contact our team here

Software Integration and Distributor Information

The appearance of CONTINUUM may vary based on the EMR vendor and technological setup of the user. If you are interested in seeing more about how CONTINUUM looks and operates, please contact our team here.

FEi Systems offers a lite front-end system that is fully integrated with the CONTINUUM software. Please contact our team to learn more.

ASAM CONTINUUM and CO-Triage are available through any EMR platform or other practice management or billing software that stores patient data. Please reference our Distributors page to view current authorized distributors. If CONTINUUM is not integrated with your EMR, please discuss your interest in CONTINUUM with your EMR representative. ASAM and FEi Systems can provide further technical and integration information to interested EMRs.

Please visit the Developer and Distributor pages of the CONTINUUM website for more details. Contact our team to discuss initiating integration of CONTINUUM into your software.

The length of integration varies based on the EMR technical department and degree of integration that is desired. On average, integration can take 12 weeks to complete.

Yes. FEi Systems provides a lite front-end system to access ASAM’s tools and can discuss this option further with interested customers. Please contact our team to learn more.

Yes. Please contact our team to learn more about the integration process.

ASAM has not yet developed this capability. However, if your system is potentially interested in supporting this development, please contact our team.

Clinical Use

The ASAM CONTINUUUM and CO-Triage are computer-guided, structured-interview tools that assist clinicians and non-clinicians in conducting expert level biopsychosocial assessments. Clinicians for whom assessment is within the scope of their practice can conduct a CONTINUUM assessment. Non-clinicians, with training and supervision, can conduct a CO-Triage assessment. ASAM does not require specific credentials to use the tool when conducting assessments, however, states or other regulatory bodies may have specific requirements around who is considered qualified to conduct an assessment.  

There is no required training or certification to purchase CONTINUUM, however, it is recommended that providers participate in our CONTINUUM training modules to appropriately navigate and utilize the software. ASAM provides several training options, including a live training course instructed by clinicians, a self-paced online course, and a hybrid course of live and self-paced instruction.   

The average time to complete a CO-TRIAGE assessment is 6 minutes. The time to complete an intake CONTINUUM assessment is variable depending on the complexity of the patient, but on average takes 60 minutes to complete for an experienced clinician. There is a learning curve in that the first 15-20 assessments may take longer as the clinician becomes familiar and experienced with the tool. These first 15-20 can take between 90 minutes to 2 hours for an intake assessment.    

CONTINUUM can be used to reassess a patient, and reassessments typically take 30 minutes to complete. The clinician has the option to pull forward responses from the previous assessment when completing a reassessment. 

Research has demonstrated that patients who are matched to treatment with ASAM CONTINUUM are more likely to engage in treatment. More than half of patients incorrectly matched to treatment dropped out, compared to about a third of patients who were matched with the ASAM CONTINUUM. Patients also exhibit two to three times better multidimensional outcomes at three months. Please reference our CONTINUUM Research page for more information.

Yes. The ASAM CONTINUUM is designed for re-assessment over time. Statistical information on treatment outcomes can be obtained from the DSM-5TR diagnostic calculations, the Addiction Severity Index sub-scale composite scores, and the CIWA/CINA withdrawal scores. More detailed views of pre- vs. post-treatment may be derived from comparing individual items or groups of items over time.

There is no required schedule for conducting a CONTINUUM interview. The ASAM CONTINUUM assessment should be administered according to the agency’s policies.

Yes. The ASAM CONTINUUM and CO-Triage require a clinical relationship and process. It is possible for misrepresentation to confound any clinical process, however, the thoroughness and multiple perspectives obtained through the ASAM CONTINUUM structured interview are designed to reduce this risk. Furthermore, interviewers are prompted to consider patient comprehension and misrepresentation in each major section of the interview process and to rate these parameters.


CONTINUUM is a comprehensive biopsychosocial assessment that collects much of the information required in reporting for Joint Commission and CARF accreditation. CONTINUUM’s items are based on the ASAM Criteria, decision rules, validated assessments such as the CIWA, CINA and ASI. This means the CONTINUUM items as written may not elicit all of the information required by these accrediting bodies. However, the comments box may be used to capture supplementary information.

The ASAM CONTINUUM internally calculates the Addiction Severity Index (ASI) composite scores for all 7 subscales: medical, employment, alcohol, drug, legal, family/social and psychological. These scores, on a 0 – 1.000 scale, may be compared across time-points to measure change over time. EMR developers are given the instructions (API code) to access these ASI scores, so that the change scores can be calculated within the EMR for clients.

Tobacco use disorder, according to DSM-5TR, is a formal, diagnosable substance use disorder. ASAM therefore specifically calls for tobacco use disorder to be treated – usually with a service intensity of Level 1 Withdrawal Management (L-1WM). This recommendation is a clinical issue and is provided independent of reimbursement considerations or service availability. Of course, if the patient has other concurrent substance use disorder issues or mental health issues, then those will necessitate additional services or a more intensive level of care.

In ASAM CONTINUUM, blood pressure & heart rate items are presented as a “yes/no” item. It is understood that some interviewers/agencies do not have the capacity to collect clinical measures of this sort. When blood pressure and heart rate are able to be assessed the CONTINUUM algorithm utilizes these to determine the need for withdrawal management.

In CO-Triage, there is an item in Dimension 6 of the screener which provides a response option reflecting instability of the living environment or homelessness. In CONTINUUM, the General Information section of the CONTINUUM assessment, the information icon for the item determining residential status instructs the interviewer on how to respond if the patient is unhoused. The tools’ goal is to assess the functional impact of housing or homelessness on the patient’s risk for continued use or relapse. The ASAM Criteria 2013 edition specifies the importance of determining if the “living...environment is not supportive of good mental health functioning”, specifically, whether “the patient is unable to cope with continuing stresses caused by homelessness”. The mere state of homelessness alone is not prescriptive, however, as to the patient’s needs. Further details on homelessness and how it affects the patient should be entered into the Comment box at the end of the Family and Social History section. These comments will be printed in the Narrative Report print-out.

The ASAM CONTINUUM specifically prompts the Interviewer to assess risks for sexual abuse during the interview. As in any clinical assessment process, if further detail emerges, the Interviewer is empowered to gather this information and it should be recorded in further depth in the Comments box at the end of the Family and Social History section. Gambling Disorder is not specifically assessed or diagnosed in the ASAM CONTINUUM or CO-Triage, as it does not directly participate in guiding Level of Care decision-making. Gambling behavior is, however, an important concern for some patients, and ASAM CONTINUUM does prompt the Interviewer to probe for any behaviors that may adversely impact readiness for recovery and risk for continued use or relapse to substance use. If such behaviors include gambling, the Interviewer is empowered to indicate this in the Comments box at the end of multiple sections. Appropriate places for gambling problem comments may include the Drug and Alcohol, Employment, Legal Information, Family and Social History, and/or Psychological sections. These comments will appear in the Narrative Report print-out. 

CONTINUUM and CO-Triage are built on the Adult ASAM Criteria therefore it is not appropriate for use with patients under the age of 18. CONTINUUM does not assess the developmental and cognitive nuance present for individuals 18 and under and therefore cannot make an accurate level of care recommendation or assessment.  At present, there are no adolescent versions of the CONTINUUM or CO-Triage assessments.

ASAM CONTINUUM is currently in use within several criminal justice settings across the US. If the patient will re-enter the community within a few months after assessment, a CONTINUUM Re-entry Interview Script Enhancement (RISE) configuration of the software is available. This version takes into account the context of the controlled environment in producing the appropriate level of care (LOC) to which the patient should be referred to upon their release. Please contact our team to further discuss whether the ASAM CONTINUUM is appropriate for your criminal justice system.

For Administrators

Yes, a CONTINUUM demo is free. Please contact our team to schedule a demo with our team. 

Please visit our detailed products page for further information regarding CONTINUUM’s applicability for your organization. If you are interested in a more detailed discussion of whether CONTINUUM is right for you and a demo of the CONTINUUM product, please contact our team to schedule a demo with our team.   

Research shows improved patient outcomes, including 30% better patient retention and two to three times better multidimensional outcomes at the three-month mark. The CONTINUUM software also streamlines and more easily secures revenue through care authorization. To view a full list of benefits, please reference here.   

If your EMR is not currently an authorized distributor, there is an initial integration fee for EMRs of $4,000, which includes customer support from FEi Systems, and an implementation technical support fee of $1,000. The retail price of ASAM CONTINUUM is $504 per user per year with a discount applied with 50 or more subscriptions. Resellers of ASAM CONTINUUM may charge up to $504 per user per year.

ASAM CONTINUUM can reduce your staff’s utilization review burden, improve payment authorization, and save patient worry. Programs in the product beta test and demonstration project phases reported substantial numbers of hours saved per patient on prior authorization and utilization review—with both commercial and public payers. Reports output from the ASAM CONTINUUM assessments can be submitted for the utilization review process to indicate level of care recommended based on CONTINUUM’s ASAM-endorsed ASAM Criteria assessment.  

Other key ways that the ASAM CONTINUUM can assist with the billing and utilization review process are:  

  • Organizing all critical information for effective managed care evaluations  

  • Tracking progress of individuals as they move along The ASAM Criteria continuum of care 

  • Assessing effectiveness of treatment with quantitative outcomes 

  • Evaluating consistency of practice  

  • Identifying gaps in treatment  

  • Reporting on access to care issues and other needs in the health system 

No, training is an additional charge and varies depending on training format.   

ASAM CONTINUUM can be purchased directly through an authorized third-party distributor or FEI Systems. ASAM is working with several health technology companies (typically companies that offer electronic health records systems) on a non-exclusive basis to offer ASAM’s CONTINUUM to the providers. A list of ASAM authorized CONTINUUM distributors can be viewed here.  

Yes, the ASAM CONTINUUM and CO-triage can be accessed through a lite front-end system provided by FEi Systems. For more information, please contact our team.   

Yes, subscriptions for CONTINUUM and CO-Triage must be purchased separately. During the integration process, both tools are incorporated into the EMR platform, however subscriptions need to be purchased separately.  

No, CO-Triage requires a separate license.

Yes, you are required to purchase a subscription to access the ASAM CONTINUUM. For more information on pricing, please reference our Distributors page.   


Users can conduct an unlimited number of assessments once they have access to the ASAM CONTINUUM.   

Large systems have used a variety of approaches to introduce the ASAM CONTINUUM software program into routine use by public treatment programs. The successful systems have used the Progressive Roll-out method. This is a grassroots engagement strategy that avoids top-down mandates that risk eliciting resistance to change.  

The Progressive Roll-out involves (1) assigning an agency official, trade association or external consultant team to (2) solicit and identify lead programs in each region. These are volunteer programs that are interested in pioneering new approaches (often to distinguish themselves competitively and establish their status as models in the region).  

Within each of these lead programs, (3) volunteer staff are invited to be the first to train on and use the software. These individuals are given formal training and followed up with supervision. After 2 to 3 months, these individuals have passed the learning curve and are efficient and skilled in the use of the software with patients.  

(4) This also allows time to determine if regional service differences or population needs require interpretation, further training, or modification of software. (5) Once these pioneer users are comfortable, it becomes easy to add the remaining users within those systems. By having these pioneer providers and their programs present to other programs in the regions, either through mini-conferences, workshops, or in-service presentations, the remaining programs in the region can be brought aboard. Similarly, in each of those second phase programs, (6) volunteers are invited to be trained and are given two to three months to adapt their skills before (7) offering the system to the remaining staff.  

Using this Progressive Roll-out approach, large systems have been able to achieve comprehensive adoption by all intake clinicians and all levels of care.  

Suitable groups for directing the progressive rollout can include internal agency work groups (including clinical directors, provider liaisons, implementation managers, etc.), or state-wide professional societies or trade associations. Financial management or payer agencies, such as Medicaid or regional managing entities, are better suited for directing the utilization review adoption of CONTINUUM recommendations rather than the Progressive Roll-out, since the latter is a clinical training process best served by prior educational in-service relationships with treatment providers.