An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement

Abstract

Tobacco use is a major threat to public health in the United States, and the number one cause of preventable death. Although most smokers try to quit unaided, robust data indicate that pairing behavioral support to US Food Drug Administration-approved cessation medications significantly increase cessation rates. Those who do receive assistance in quitting usually receive very low intensity treatment, regardless of the severity of their dependence or their medical and environmental circumstances. This is in stark contrast to how other substance use disorders are treated, where there are varying levels of care depending on addiction severity and biopsychosocial circumstances. The American Society of Addiction Medicine (ASAM) developed a formal algorithm for assessing substance use disorders and determining the optimal level of care. The ASAM Patient Placement Criteria are regularly used to determine the appropriate level of care for all substance use disorders except tobacco. This paper will review key aspects of the ASAM dimensions of care and placement levels, with emphasis on how they apply to tobacco use and present case examples of typical smokers who would benefit from a higher intensity of tobacco dependence treatment. We also present current barriers to reimbursing healthcare providers for these services. We conclude with a commentary and discussion regarding recommendations for improvements in tobacco dependence treatment care.

Integration of Tobacco Treatment Services into Cancer Care at Stanford

“…Reported barriers to routinely providing cessation support were inadequate training (38%) and perceiving patients as resistant to tobacco treatment (74%) [19]. Asking about tobacco use and advising cessation are necessary first steps for treating tobacco addiction; however, ongoing support and combination treatment often are necessary to prevent relapse [20]. Insurance coverage for tobacco treatment in the U.S. also remains inconsistent and often non-comprehensive, creating access challenges for patients.…”

Enrollee Characteristics in an Intensive Tobacco Dependence Treatment Program: The Relationship of Race and Sex to Demographic Factors and Tobacco Use Patterns

“…In addition, a sizable portion indicated the presence of a mental health or substance dependence condition. Such a profile is indicative of individuals who are likely to have considerable difficulty quitting tobacco, particularly on their own, or when employing self-help or lower intensity interventions (26–29). These findings support the general premise that intensive treatment programs are needed to address the needs of this segment of the tobacco-using population, and available evidence indicates positive outcomes can be achieved [e.g., (25, 30)].…”

Efficacy of a short-term residential smoking cessation therapy versus standard outpatient group therapy (‘START-Study’): study protocol of a randomized controlled trial

“…In an effort to increase the long-term efficacy of smoking cessation for strong addictions, the American Society of Addiction Medicine (ASAM) developed an algorithm to intensify procedures for smoking cessation from unassisted self-help over counseling and outpatient group therapy (combined with medication) to a residential therapy away from the patient's daily environment and habits [20]. It can be assumed that high-intensity residential smoking cessation therapy has several advantages over interventions in outpatient contexts [21].…”