title: No-Show for Treatment in Substance Abuse Patients with Comorbid Symptomatology: Validity Results from a Controlled Trial of the ASAM Patient Placement Criteria.
abstract: OBJECTIVE
  : Mismatched placement, according to the American Society of Addiction Medicine's (ASAM) Patient Placement Criteria (PPC), promotes no-shows to treatment; however, little is known about the impact on patients with psychiatrically comorbid substance use disorder.
  
  
  METHODS
  : In a multisite trial, public-sector treatment-seeking adults (N = 700), following a computer-assisted ASAM PPC-1 structured interview, were blindly scored and randomly assigned to Level-of-Care (LOC)-II (intensive outpatient) or LOC-III (residential) settings. Patients scored as needing LOC-II but assigned to LOC-III were, by definition, "overmatched."
  
  
  RESULTS
  : Among 143 overmatched patients, no-shows were significantly higher in comorbids versus noncomorbids (54% versus 28%; P < 0.01). Among overmatched comorbids, patients who no-showed compared with patients who showed were more likely to be females (70.4% versus 34.8%; P < 0.05), to have anxiety (63% versus 17.4%; P < 0.01), or have supportive family/social environments (81.5% versus 34.8%; P < 0.01).
  
  
  CONCLUSIONS
  : The data support the validity of the PPC for matching comorbid patients. Mismatching increases no-show rates in general with undermatching, but it does so in particular with overmatching in patients with comorbid psychiatric symptomatology. Comorbidity interacts with gender, overmatched status, presence of anxiety, and supportive environment as predictors of treatment no-shows (odds ratios = 2.69, P < 0.05; 3.27, P < 0.05; 5.32, P < 0.001; and 3.12, P < 0.05, respectively).
authors.affiliation: From the Addiction Research Program, Department of Psychiatry (GAA, SP, SL, ES, DRG), Massachusetts General, Hospital/Harvard Medical School, West End House Clinic, Boston, MA; Department of Psychiatry (GAA), Yale University School of Medicine, New Haven, CT; Institute for Behavioral Health (SR), Heller School, Brandeis University, Waltham, MA; Department of Psychiatry (SP), University of Liège, Liège, Belgium; Alkermes, Inc. (DRG), Cambridge, MA.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Angarita
authors.forename: Sharon
authors.initials: S
authors.lastname: Reif
authors.forename: Sandrine
authors.initials: S
authors.lastname: Pirard
authors.forename: Sang
authors.initials: S
authors.lastname: Lee
authors.forename: Estee
authors.initials: E
authors.lastname: Sharon
authors.forename: David R
authors.initials: DR
authors.lastname: Gastfriend