Feasibility of matching alcohol patients to ASAM levels of care.
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.
Kosanke
Nicole
N
Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY, USA.
Magura
Stephen
S
Staines
Graham
G
Foote
Jeffrey
J
DeLuca
Alexander
A
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