ASAM Vignettes
A 42-year-old male with severe alcohol use disorder presents for admission after drinking a fifth of vodka daily for several years. He reports tremors, sweating, nausea, and anxiety when attempting to stop drinking. His last drink was 12 hours ago. He has no history of seizures or delirium tremens. Vital signs are stable, and he is alert and oriented. He wants treatment and has supportive family members available to assist at home.
Based on ASAM 4th Edition, which factor should have the greatest influence on determining the appropriate withdrawal management level of care?
A. The diagnosis of severe alcohol use disorder
B. The patient's age and gender
C. The current and anticipated severity of withdrawal risk in Dimension 1
D. The availability of a residential treatment program
C. The current and anticipated severity of withdrawal risk in Dimension 1
Which Adult & Geriatric Psychiatry subset would typically be selected when services are provided several hours per day but the member does not require 24-hour psychiatric care?
A. Behavioral Health Observation
B. Partial Hospital Program
C. Residential Treatment Center
D. Supervised Living
Answer: B ✅
Rationale: Partial Hospital Program is one of the Adult & Geriatric Psychiatry levels of care between inpatient and outpatient services. [Review Process Document]
Care Management Information in Adult & Geriatric Psychiatry appears:
A. For every level of care
B. Only in Residential Treatment Center reviews
C. Only for Inpatient reviews
D. Only for Outpatient reviews
Answer: C ✅
Rationale: Care Management Information appears when completing an Adult & Geriatric Psychiatry Inpatient review. [Quick Refe...y Products | PDF]
What score indicates Independent Criteria requiring admission to Level 6 (inpatient) regardless of the overall/composite score?
A. Score of 5 on Dim 1, 2 or 3
B. Score of 5 on Dim 1 only
C. Score of 4 on Dim 1, 2 or 3
D. Score of 3 on Dim 1, 2, 3
A. Score of 5 on Dim 1, 2 or 3
True or False? Level 2.5 programs are able to provide necessary supports that include:
True
(Information pulled directly from Level 2.5 subset note)
A 29-year-old female with opioid use disorder has completed withdrawal management and is medically stable. She is motivated for treatment, attends counseling, and demonstrates good insight. However, she lives with several individuals actively using fentanyl, has no sober supports, and reports multiple recent relapses after returning home from treatment.
Which ASAM dimension is most directly contributing to her continued risk?
A. Dimension 2: Biomedical Conditions
B. Dimension 4: Readiness to Change
C. Dimension 5: Continued Use, Relapse, or Continued Problem Potential
D. Dimension 6: Recovery Environment
D. Dimension 6: Recovery Environment
Which InterQual Psychiatry product includes a Subacute Care level of care?
A. Adult & Geriatric Psychiatry
B. Child & Adolescent Psychiatry
C. ASAM Adult 4th Edition
D. ASAM Adolescent 3rd Edition
Answer: B ✅
Rationale: Subacute Care is listed as a Child & Adolescent Psychiatry level of care. [2026 IQ Ch...ew Process | PDF]
In the online LOCUS tool, which Level of Care Description do we NOT use for 2026 IRR testing?
A. Adult LOCUS levels of Care
B. Child/Adolescent CALOCUS Levels of Care
C. Child/Adolescent CALOCUS-CASII Levels of Care
B. Child/Adolescent CALOCUS Levels of Care
(Per 7/16 prep training)
*HOT TIP: Once you click on the level of care for your IRR question- you can often locate the answer in the first three paragraphs (Josh)
Fill in the 3 blanks:
We are currently using LOCUS Version ____, CALOCUS_CASII Version ____ and there are ___ Dimensions evaluated in the LOCUS/CALOCUS criteria.
While we ARE currently using LOCUS Version 20, CALOCUS_CASII Version 2020, there are SIX dimensions in the LOCUS/CALOCUS criteria.
Multiple choice: A patient might need integrated medical management if their needs require more than ____ contact with a medical provider; they are unable to access adequate care externally; or they are assessed as needing integrated medical management to permit effective participation in addiction treatment.
A. daily
B. weekly
c. routine
A. A patient might need integrated medical management if their needs require more than WEEKLY contact with a medical provider
A 36-year-old male with stimulant use disorder is requesting admission to treatment. He reports recent paranoia, auditory hallucinations, and insomnia after several days of methamphetamine use. He has no active suicidal ideation. The treatment team is attempting to determine whether his psychiatric symptoms can be safely managed within the requested level of care.
Which ASAM dimension is primarily being assessed?
A. Dimension 1: Acute Intoxication and Withdrawal Potential
B. Dimension 2: Biomedical Conditions and Complications
C. Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications
D. Dimension 5: Relapse Potential
C. Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications
According to ASAM Navigator, what are the key differences between a HIGH or MODERATE likelihood of imminent risky substance use/SUD-related behaviors and how quickly member is likely to return to use if no clinical intervention were provided?
A. Level of skills to avoid behaviors
B. Level of family/friends involvement in treatment
C. Frequency of clinical support received
D. Employment Prospects
E. Level of structure to maintain sobriety
F. A, B, D & E
G. A, C & D
H. A, C, E
H. A, C, E
Level of skills to avoid behaviors
Frequency of clinical support received
Level of structure to maintain sobriety
In The ASAM Navigator, "Non-Intensive" refers to services provided less than:
A. 5 days per week
B. 1 day per week
C. 3 days per week
D. Twice per month
C. 3 days per week
True or False
If a member has chronic symptoms or ongoing issues, they will be rated higher in that parameter/dimension
FALSE
In The ASAM Criteria, medical services are services that are directed and delivered by medical staff to address concerns in which Dimensions?
Dimensions 1, 2, and/or 3.
A 51-year-old member with alcohol use disorder has been participating in intensive outpatient treatment for four weeks. Attendance is consistent, cravings have decreased, no substance use has been reported, and treatment goals are largely achieved. The member has developed a relapse prevention plan, engages in mutual support meetings, and has strong family support. The provider requests continued treatment at the same level of care.
Based on ASAM 4th Edition principles, what is the most appropriate next step?
A. Approve continued stay because treatment has been successful.
B. Consider transition to a less intensive level of care if current needs can be safely met there.
C. Increase the level of care to prevent relapse.
D. Approve one additional month before reassessing.
B. Consider transition to a less intensive level of care if current needs can be safely met there.
Name 3 of the 5 examples of negative, but not seriously destabilizing consequences of continued substance use outlined in Dimension 4 for Risky substance use/SUD-related behaviors. (Key words are acceptable)
Inability to establish/maintain relationships
Inability to establish/maintain steady employment
Family/Interpersonal Conflict
Minor Legal Challenges
Minor Financial Challenges
When preparing for InterQual IRR testing, you need to locate the definition of an "Episode Week." Which resource is most likely to provide it?
A. Provider Manual
B. Review Process Document
C. Benefit Grid
D. Authorization Letter
Answer: B ✅
Rationale: Review Process documents contain definitions and terminology such as Episode Day/Week.
Fill in the blanks: The AACP recommends using LOCUS to assess adults in age range _____ and CALOCUS_CASII with children and adolescents in age range _______.
A. 18 and above, ages 6-17
B. 21 and above, ages 6-20
C. 16 or older, ages 5-15
A. 18 and above, ages 6-17
A 15-year-old male is referred for residential treatment following a recent relapse. He reports cannabis use on two occasions in the past month. He has no withdrawal symptoms, no significant mental health concerns, strong family support, is attending school, and states he wants help to avoid future substance use.
Based on the information provided, what additional information would be most important before determining the need for residential treatment?
A. Favorite school subject
B. Recent physical examination results
C. Multidimensional assessment of severity and risk across all six ASAM dimensions
D. Number of previous outpatient therapy sessions
False: Patients who will not initiate MOUD, (not patients who have initiated MOUD)
A 17-year-old was referred for treatment after being suspended from school for vaping THC on campus. He denies having a substance use problem and states, "I'm only here because my parents made me come." He participates minimally in sessions but has continued attending appointments.
Which ASAM dimension is most relevant to understanding his current treatment needs?
A. Dimension 2: Biomedical Conditions
B. Dimension 4: Readiness to Change
C. Dimension 5: Relapse Potential
D. Dimension 6: Recovery Environment
B. Dimension 4: Readiness to Change
True or False: Instrumental ADLs (IADLs) are more complex tasks that involve interactions with others and with the environment and enable a person to live independently. People with mental illness and poor IADLs may be unable to live without structured support. All of these are examples of IADL's according to InterQual: cooking, cleaning, managing finances, communicating with others, and traveling outside the home (e.g., shopping, attending appointments).
True
Which of the following statements about using the LOCUS_CALOCUS-CASII instruments is NOT TRUE?
A. Each dimension has a 1-5 point rating scale
B. Only one criterion needs to be met for that rating to be selected
C. It's important to read between the lines on every IRR test question to get the correct answer.
D. The instrument includes a dimension for treatment resources.
C & D are NOT TRUE
True or False:
The LOCUS/CALOCUS criteria are designed to determine the most appropriate level of care regardless of the diagnosis.
TRUE
Which 2 of the following non-life-threatening pregnancy complications may require frequent medical monitoring in a medically managed addiction treatment program according to the The ASAM Criteria 4th ed., Chapter 10, "Dimensional Admission Criteria" - Dimension 2, "Pregnancy-related concerns" decision rules:
A. Uncontrolled UTI
B. Chronic HTN
C. Patient history of 3rd trimester miscarriage
D. Stable gestational diabetes
E. A & B
F. B & D
G. All of the above
F. B & D (Chronic HTN & Stable gestational diabetes)