Predictive Validity of the ASAM Patient Placement Criteria for Naturalistically Matched vs. Mismatched Alcoholism Patients

Abstract

This study examined the predictive validity of the ASAM Patient Placement Criteria for matching alcoholism patients to recommended levels of care. A cohort of 248 patients newly admitted to inpatient rehabilitation, intensive outpatient, or regular outpatient care was evaluated using both a computerized algorithm and a clinical evaluation protocol to determine whether they were naturalistically matched or mismatched to care. Outcomes were assessed three months after intake. One common type of undertreatment (ie, receiving regular outpatient care when intensive outpatient care was recommended) predicted poorer drinking outcomes as compared with matched treatment, independent of actual level of care received. Overtreatment did not improve outcomes. There also was a trend for better outcomes with residential vs. intensive outpatient treatment, independent of matching. Results were robust for both methods of assessment. Corroboration by more research is needed, but the ASAM Criteria show promise for reducing both detrimental undertreatment and cost-inefficient overtreatment.

Convergent Validity of the ASAM Criteria in Co-Occurring Disorders

“…The clinical improvements in both groups suggest that the services provided in this region have the capability to deal with more acute and severe co-occurring disorders, and given the right intensity of treatment both groups can have successful outcomes. This is in line with prior research that shows better outcomes with the appropriate intensity and integration of services to treat both disorders (Sharon et al, 2003;Magura et al, 2003;Brunette et al, 2004). Patients with more severe substance abuse, less social support, or co-occurring psychological disorders benefit more from inpatient versus outpatient treatment Bartak et al, 2011).…”

“…Although these differences were not statistically significant, the trend is consistent with the ASAM Criteria's intent to place individuals with more severe needs in more intensive treatment services. Prior research has shown better outcomes with this type of intensity and service integration matching to treat both disorders (Sharon et al, 2003;Magura et al, 2003;Brunette et al, 2004). Patients with more severe substance abuse, less social support, or comorbid psychological disorders benefited more from initiating care with inpatient as opposed to outpatient treatment Bartak et al, 2011).…”

“…The validity of the ASAM Criteria first edition has been supported by several studies (Center for Substance Abuse Treatment, 1995;Baker & Gastfriend, 2003;Sharon et al, 2003;Staines et al, 2003;Magura et al, 2003). The revised version of the ASAM Criteria introduced taxonomy of addiction treatment programs Downloaded by [Radboud Universiteit Nijmegen] at 03:14 05 November 2014 based on their capacity to provide services to people with dual diagnosis (Mee-Lee et al, 2001).…”

Was meint „good practice” in der Suchtarbeit?

“…Auswertungsstudien dieser Placierungspraxis ergaben eine Akzeptanz und Umsetzbarkeit von rund 50 % [12] . Das niederl ä ndische Modell MATE (Measurement in the Addictions for Triage and Evaluation) eines solchen " stepped care " Konzeptes ben ü tzt als Indikatoren die Konsumgewohnheiten inkl.…”

Evidence-based treatment: Why, what, where, when, and how?

“…The Patient Placement Criteria of the American Society of Addiction Medicine (2001), which offer decision rules for placing patients into various levels of treatment intensity, began as a professional consensus document; subsequent studies have shed light on the reliability, validity, and utility of these criteria and helped refine them (Gastfriend, 2003;Magura et al, 2003). Professional consensus is also the standard used to develop the Treatment Improvement Protocols published by the U.S. Center for Substance Abuse Treatment.…”