Diagnostic & Statistical Manual
American Society of Addiction Medicine
DSM ASAM
Diagnosing
For many new clinicians, diagnosing can feel intimidating at first; however, it becomes more manageable with practice and the right resources. The Diagnostic and Statistical Manual of Mental Disorders (DSM) serves as the primary reference guide for mental health professionals. Utilizing the DSM, along with reputable online resources, can help clinicians make accurate diagnostic decisions and increase confidence in the assessment process.
Dual Diagnoses
Some individuals may meet criteria for more than one diagnosis. In these cases, the most prominent or clinically significant condition is identified as the primary diagnosis, while additional conditions are considered secondary diagnoses. Distinguishing between primary and secondary diagnoses is important, as it can impact treatment planning and provider eligibility. For example, chemical dependency counselors are generally authorized to provide treatment only when a substance use disorder is the client's primary diagnosis.
ASAM Criteria
The American Society of Addiction Medicine (ASAM) Criteria is another valuable resource for clinicians working with individuals experiencing substance use disorders. The ASAM Criteria helps determine the appropriate level of care based on a comprehensive assessment of an individual's needs. It is also widely used by Medicaid programs and insurance providers to guide authorization decisions and reimbursement for treatment services.
Levels of Care in Addiction Treatment
Addiction treatment is often structured as a step-down continuum of care, allowing individuals to receive the level of support most appropriate to their needs and gradually transition to less intensive services as they progress in recovery. Lengths of stay may vary based on individual circumstances, severity of symptoms, and treatment goals.
Beginning outpatient therapy immediately following discharge from inpatient treatment is strongly recommended. Individual therapy can help clients begin processing trauma and addressing underlying issues early in recovery, which may improve long-term recovery outcomes.
Typical Levels of Care and Average Lengths of Stay
Detoxification (Highest Level of Care)
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Approximately 3–15 days, depending on medical necessity and symptom severity
Inpatient/Residential Treatment
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Approximately 1–90 days
Partial Hospitalization Program (PHP)
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Approximately 1–20 days
Intensive Outpatient Program (IOP)
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Approximately 3 months
Outpatient Services
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Individual Therapy: Ongoing
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Peer Support Services: Ongoing
Sober Living Housing
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Approximately 1–12 months, depending on individual needs and recovery goals
Helpful Resources:
Understanding Mental Health, Behavioral Health, Personality Disorders, Dual Diagnosis, and Addiction
These terms are often used interchangeably, but they refer to different aspects of an individual's overall well-being and treatment needs.
Mental Health (MH)
Mental health refers to a person's emotional, psychological, and social well-being. It influences how individuals think, feel, cope with stress, make decisions, and relate to others.
Examples of mental health disorders include:
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Depression
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Anxiety disorders
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Bipolar disorder
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Schizophrenia
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Post-traumatic stress disorder (PTSD)
Mental health conditions are generally characterized by changes in mood, thinking, perception, or emotional functioning.
Behavioral Health (BH)
Behavioral health is a broader term that encompasses both mental health and behaviors that affect overall health and wellness. It focuses on how behaviors impact physical and emotional well-being.
Behavioral health concerns may include:
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Mental health disorders
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Substance use disorders
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Gambling disorders
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Eating disorders
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Self-destructive behaviors
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Lifestyle habits that affect health
In simple terms, mental health is one component of behavioral health.
Personality Disorders
Personality disorders are a category of mental health conditions characterized by enduring patterns of thinking, feeling, relating to others, and behaving that differ significantly from cultural expectations and cause impairment or distress.
These patterns are typically:
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Long-standing
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Rigid and difficult to change
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Present across multiple settings and relationships
Examples include:
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Borderline Personality Disorder (BPD)
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Narcissistic Personality Disorder (NPD)
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Antisocial Personality Disorder (ASPD)
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Obsessive-Compulsive Personality Disorder (OCPD)
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Avoidant Personality Disorder
Unlike conditions such as depression or anxiety, personality disorders affect the way a person experiences themselves, others, and the world over time.
Addiction (Substance Use Disorders)
Addiction is a chronic condition involving compulsive use of a substance or engagement in a behavior despite negative consequences. Addiction affects brain reward, motivation, memory, and decision-making systems.
Examples include:
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Alcohol use disorder
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Opioid use disorder
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Stimulant use disorder
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Cannabis use disorder
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Gambling disorder
Common features include:
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Cravings
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Loss of control
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Continued use despite harm
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Tolerance
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Withdrawal symptoms
Addiction is considered both a behavioral health condition and a medical condition.
Dual Diagnosis (Co-Occurring Disorders)
A dual diagnosis occurs when an individual has both a mental health disorder and a substance use disorder at the same time.
Examples:
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Depression and alcohol use disorder
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PTSD and opioid use disorder
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Bipolar disorder and stimulant use disorder
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Anxiety disorder and cannabis use disorder
Both conditions interact with one another and often require integrated treatment. Untreated mental health symptoms can contribute to substance use, and substance use can worsen mental health symptoms.