The ASAM Criteria^® is the most respected, comprehensive and widely used set of clinical standards for providing outcome-oriented care in the treatment of addiction. The ASAM Criteria plays a critical role in national efforts to advance treatment standards for the disease of addiction. The common language and universal standards set by The ASAM Criteria establish a framework to help payers and healthcare systems ensure they are offering the full continuum of care to meet patients’ needs.

ASAM strongly supports the expanded use of clinical standards of care, including The ASAM Criteria, throughout the addiction treatment system. Correct implementation of these standards is critical for effective treatment planning and care delivery.

Recent growth in use of The ASAM Criteria has been accompanied by increasing reports of misuse and unapproved use by some providers and payers. In some cases, parts of The ASAM Criteria standards are used but they are not implemented comprehensively. These actions threaten the long-term credibility and integrity of The ASAM Criteria and undermine the efforts of providers and payers who implement it correctly. ASAM has a responsibility – to providers, payers, regulators, patients and their families – to ensure The ASAM Criteria continues to be equated with high-quality care proven to be effective in addiction treatment.

To that end, ASAM is embarking on a number of modifications to The ASAM Criteria copyright permissions processes. This includes a permissions agreement process to authorize use of ASAM’s intellectual property with a disclaimer that helps avoid any confusion among patient, families, providers or payers. To learn more, visit the Criteria copyright permissions page.

The ASAM Criteria includes standards for multiple components of care, including: (1) a standardized multidimensional assessment; (2) standard decision rules for interpreting the multidimensional assessment and matching the patient to the right level of care to meet their treatment needs; and (3) standard service characteristics that define each level of care in the care continuum. These components all work in tandem to ensure that the patient is matched to the right level of care to meet their individual needs.

To fully implement The ASAM Criteria within the addiction treatment system all elements must be in place:

• Patients entering addiction treatment should receive a standard multidimensional assessment that covers all six dimensions described in The ASAM Criteria.
• The standard patient placement decision rules in The ASAM Criteria should be used to interpret the assessment and match the patient to the right level of care to meet their treatment needs.
• Payers and managed care organizations should use the same standard decision rules to determine what level of care will be covered for an individual patient.
• The treatment program should meet all the standard service characteristics for the level(s) of care that they provide.
• The treatment system should provide access to all levels of care in the care continuum as described in The ASAM Criteria standards.
• The multidimensional assessment and patient placement decision rules should be re-used as the patient progresses through treatment to determine when they should be moved to another level of care (either higher or lower depending on the individual patient’s symptoms and circumstances).
• Healthcare providers and utilization review managers should be well trained in The ASAM Criteria to support effective decision making.

ASAM is working to provide tools to support comprehensive and effective implementation across all the components described in the previous question. For example:

• The  ASAM CONTINUUM provides a standard multi-dimensional assessment that covers all six dimensions and applies the decision rules in The ASAM Criteria in an algorithm that provides a level of care recommendation.
  • The ASAM CONTINUUM can be used by healthcare providers to make a level of care recommendation for each patient and by payers to facilitate utilization review decisions.
• ASAM is currently developing a robust 8-hour training program on The ASAM Criteria for healthcare providers and we plan to expand our course offerings for other stakeholders, including utilization review staff.
• The ASAM Level of Care Certification program is currently under development, in partnership with CARF International, and will provide a process for validating that individual treatment programs have the capacity to deliver an ASAM level of care.
• ASAM also develops expert-consensus based clinical guidelines to support delivery of the current standards of care for addiction treatment.
  • ASAM implements processes to ensure that all ASAM clinical standards are consistent, developed with the best evidence available, and free of bias.

These tools will help to support greater standardization and objectivity in the implementation of The ASAM Criteria by both healthcare providers and payers:

It will take time to build all the tools that are needed to robustly support implementation of The ASAM Criteria. In the short-term the copyright permissions process changes will help ASAM protect the integrity of The ASAM Criteria by:

• restricting the use of The ASAM Criteria brand to providers that are mandated to do so, and those that are implementing ASAM endorsed products to support effective implementation of standards (e.g. ASAM CONTINUUM, ASAM Level of Care Certification, ASAM Criteria Training),
• requiring a disclaimer that makes it clear to patients, family members, and others that the program is not certified as an ASAM Level of Care or endorsed by or affiliated with ASAM, and
• giving ASAM the authority to take away the right to use The ASAM Criteria name and to tell organizations that are mispresenting The ASAM Criteria to cease and desist.

In the longer-term the tools that are under development are a better way to support effective implementation of The ASAM Criteria. For example, the ASAM Level of Care certification program is ultimately a more effective way to ensure that a program has the capacity to deliver an ASAM Level of Care.  However, it will take time to develop the certification programs for all levels of care and certify providers, and it is important for ASAM to take steps to protect the integrity of The ASAM Criteria in the meantime.

The following types of providers and care delivery organizations are eligible for permission to publish or market the use The ASAM Criteria:

• Providers required to do so by a public entity or payer;
• Providers using other endorsed ASAM Criteria related products to support effective implementation (e.g. ASAM CONTINUUM or CO-Triage; see Q14 below); and
• Providers that have been certified by CARF as an ASAM Level of Care (see Q13 below).

Additionally, the following types of entities and organizations are eligible for permission to publish or market the use of The ASAM Criteria:

• States, health plans and insurers, and other regulators and payers that wish to require the use of The ASAM Criteria;
• Managed care entities, third-party vendors, and related entities that use The ASAM Criteria in their operations; and
• Publishers or authors who want to reproduce un-modified content from The ASAM Criteria (with attribution) in a publication (e.g., book, scholarly journal).

Permissions requests from other entities, individuals, or organizations will be evaluated on a case-by-case basis.

No. Providers do not need a permission agreement to implement The ASAM Criteria or to certify their compliance with relevant state requirements.  However, a permission agreement is needed for any provider that wishes to publish or market their use of The ASAM Criteria, or to otherwise use ASAM materials or trademarks in connection with the sale, offering for sale, distribution, or advertising of any goods or services. 

ASAM recognizes that these changes will be a transition for the field. We plan to use a phased approach, working with a few states at a time and modifying the program as necessary to address the nuances of individual states’ implementation of The ASAM Criteria and any unintended consequences of the updated permission process. ASAM will work in partnership with states and other public entities to find the balance for supporting states’ efforts to reform the addiction treatment system while protecting the integrity of The ASAM Criteria.

U.S. Copyright Law exempts certain limited use of copyrighted works, referred to as "fair use," and such uses are permissible without a license or permissions agreements. The law requires that a good faith determination be made based on the balance of four factors: purpose and character of the use, nature of the copyrighted work, amount and substantiality of the portion used in relation to the copyrighted work as a whole, and effect of the use upon the potential market for or value of the copyrighted work. These factors are subject to interpretation, and careful analysis is required. Consulting with legal advisors is encouraged. When in doubt, please contact ASAM to discuss any questions about obtaining a no-cost permissions agreement for educational purposes.

ASAM acknowledges uses for educational purposes to be within fair use and does not require a permissions agreement for such purposes. ASAM looks to existing copyright law to define an educational purpose to include material used in educational institutions and for educational purposes. Examples of educational institutions include K-12 schools, colleges, and universities. Libraries, museums, hospitals, and other public entities and nonprofit institutions also are considered educational institutions under most educational fair use guidelines when they engage in nonprofit instructional, research, or scholarly activities for educational purposes.

ASAM further defines educational purposes to include:

• Noncommercial instruction or curriculum-based teaching by educators to students at nonprofit educational institutions
• Planned noncommercial study or investigation directed toward making a contribution to a field of knowledge, or
• Presentation of research findings at noncommercial peer conferences, workshops, or seminars.
• Basic introductory trainings to familiarize staff with the basic conceptual framework for The ASAM Criteria, ASAM multidimensional assessment, and/or ASAM levels of care.

Training programs on The ASAM Criteria do not qualify for a fair use exception.

As noted above, minimal use of The ASAM Criteria name and/or citations to the content may also qualify for a fair use exception. Unless an intended use falls within the narrow exceptions described in this response, a license or permission agreement is necessary.

No.  Public entities and providers do not need to obtain a permission agreement to sponsor basic introductory trainings to familiarize staff with the basic conceptual framework for The ASAM Criteria, ASAM multidimensional assessment, and/or ASAM levels of care.  These types of trainings typically fall under the fair use guidelines and do not infringe upon ASAM copyrights.  ASAM generally considers education or trainings to be fair use if they:

• Provide a high-level overview of The ASAM Criteria, CONTINUUM, CO-Triage, or related products or content

• Do not assess implementation of The ASAM Criteria by a specific provider, facility, organization, or public entity
• Do not claim to train, certify, or otherwise qualify providers or staff to use The ASAM Criteria in clinical practice or business operations
• Properly disclaim that the instructor, course, and training materials are not sponsored or endorsed by ASAM
• Do not reproduce copyright-protected content beyond the information provided on the ASAM website

However, ASAM does not consider republication or public dissemination of its content, or incorporation of its content into the publications of others, to be fair use.

For individuals or organizations interested in obtaining permission to provide trainings on The ASAM Criteria that go beyond our fair use policy please contact ASAMCriteria@asam.org.

U.S. Copyright Law exempts certain limited use of copyrighted works, referred to as "fair use," and such uses are permissible without a license or permissions agreements. The law requires that a good faith determination be made based on the balance of four factors: purpose and character of the use, nature of the copyrighted work, amount and substantiality of the portion used in relation to the copyrighted work as a whole, and effect of the use upon the potential market for or value of the copyrighted work. These factors are subject to interpretation, and careful analysis is required. Consulting with legal advisors is encouraged. When in doubt, please contact ASAM to discuss any questions about obtaining a no-cost permissions agreement for educational purposes.

ASAM considers certain uses of, and references to, ASAM trademarks and copyrighted material in statutes, regulations, or other government policy documents to fall within the Fair Use doctrine and to be permissible without a permission agreement.  Similarly, ASAM considers limited uses by providers who reference their use of The ASAM Criteria for regulatory purposes and to the extent necessary to comply with the law to qualify as fair use.  For example, providers do not need a permission agreement to implement The ASAM Criteria or to certify their compliance with relevant state requirements.  However, a permission agreement is needed for any provider that wishes to publish or market their use of The ASAM Criteria, or to otherwise use ASAM Criteria content or trademarks in connection with the sale, offering for sale, distribution, or advertising of any goods or services. 

Click here for information on how to apply for a permissions agreement.

Permissions agreements for states and other public entities will be free of charge. Click here to complete the permission request form.

Permissions agreements for providers will be reasonably priced to cover the costs associated with ensuring that provider use of The ASAM Criteria is reliably and consistently represented. To receive more information on provider rates, click here to complete the permission request form.

Permissions agreements for payers & managed care entities are based on the number of licenses requested and total covered lives. Click here to complete the permission application form. 

Permissions agreements for educators: For educational content outside of the Fair Use guidelines (detailed here), rates will be determined based on the amount of content requested and intended scope of distribution. Complete the training permission request form.

Permissions agreements for technology vendors: ASAM will review permission requests from technology vendors on a case-by-case basis. Rates will be determined based on the amount of content requested, scope of distribution, and other relevant factors. Click here to complete the application form.

Permissions agreements for reuse of ASAM Criteria content in publications (e.g., book, scholarly journals) will be priced based on type and amount of content being used and intended scope of distribution. Click here to complete the application form.

ASAM is rapidly working to develop a range of programs designed to support effective implementation of The ASAM Criteria, including:

• The ASAM Level of Care Certification Program™ provides an independent assessment of a treatment program’s ability to deliver services consistent with The ASAM Criteria®. Delivered in partnership with CARF International (CARF), is the first program of its kind to independently assess and verify treatment programs’ capacity to deliver services consistent with the level of care standards described in The ASAM Criteria.
• A robust training program on The ASAM Criteria, and
• Enhancements to the ASAM CONTINUUM software program (a decision support tool for determining the right level of care for a patient based on The ASAM Criteria).

These are two separate, but complementary programs.

The ASAM Level of Care Certification program administered by CARF International will be issued to programs that demonstrate that they have the capacity to deliver a specific ASAM level of care. Programs that achieve certification will be authorized to advertise that it offers the specific ASAM levels of care covered by its certification and to display the ASAM level of care certification seal at the facility.

The provider permissions agreements will give the legal authority to use ASAM’s intellectual property with a disclaimer clarifying that they are not affiliated with or endorsed by ASAM to help avoid any confusion among patient, families, providers or payers.

Providers who receive an ASAM Level of Care Certification from CARF International will not need a permissions agreement to reference their ASAM Level of Care certification. However, they will need a permissions agreement to reference their use of The ASAM Criteria in other ways (e.g. if they make reference to using The ASAM Criteria for patient placement recommendations).

ASAM CONTINUUM customers will not need a permission agreement to reference their use of the software or The ASAM Criteria to make patient placement recommendations. However, ASAM CONTINUUM customers will need a permissions agreement to reference their use of The ASAM Criteria in other ways (e.g. to designate their program as an ASAM level of care).

More information about our copyright and permissions process can be found on the ASAM copyright and permissions webpage.