title: Feasibility of matching alcohol patients to ASAM levels of care.
abstract: The study examined the feasibility of implementing treatment recommendations derived from the American Society of Addiction Medicine (ASAM) Patient Placement Criteria in an urban addiction treatment program that offered a continuum of levels of care (LOC). A cohort of 281 applicants for alcoholism treatment were evaluated and the reasons for observed differences ("mismatches") between recommended and actual LOC placements were determined. Overall, 88% of the applicants entered treatment, and 72% of these were matched to LOC vs. 28% who were mismatched. Presumptive overtreatment (59%) was more common than undertreatment (41%) among the mismatched patients. The reasons for overtreatment were availability of Medicaid coverage for inpatient rehabilitation (93%), referral sources' treatment philosophy of gradually "stepping down" from inpatient detoxification (59%), social pressures on patients (28%), and mandated treatment (8%). The reasons for presumptive undertreatment were work schedule conflicts (72%), patient reluctance (48%), insurance coverage (15%), and interference with family or personal responsibilities (9%). These results indicate multiple barriers that need to be overcome to enable full implementation of the ASAM Criteria in real world program settings, even when a continuum of care is available.
authors.affiliation: Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kosanke
authors.forename: Stephen
authors.initials: S
authors.lastname: Magura
authors.forename: Graham
authors.initials: G
authors.lastname: Staines
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Foote
authors.forename: Alexander
authors.initials: A
authors.lastname: DeLuca
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods; D010349:Patient Compliance; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D012955:Societies, Medical