Research on the ASAM Criteria

Since the publication of the first edition, there has been over a decade of experience with the ASAM criteria. Use of the second edition (ASAM PPC-2; Mee-Lee, Shulman et al., 1996) has been mandated or recommended to publicly funded treatment programs in nearly 30 states, by the U.S. Department of Defense, and by two large health maintenance organizations. While this does not constitute universal acceptance, there clearly is movement toward the common language they provide to the providers and managers of care, as well as a strong focus on multidimensional assessment and individualized care.

Formal research into the criteria also is encouraged. In the earliest such study (Plough, Shirley et al., 1996), counselors used a simple, one-page summary of the criteria. The results suggested that use of even a primitive version of the ASAM criteria is associated with improved treatment retention.

In 1994, the National Institute on Drug Abuse (NIDA) funded the first randomized controlled trial using the ASAM criteria, and it is hoped that clinical outcomes research will drive future revisions of the criteria. There also have been two retrospective studies: one applied an abbreviated PPC-1 algorithm to telephone survey data (Morey, 1996), while the other implemented only the psychosocial dimensions (McKay, Cacciola et al., 1997). A solution has been developed to address the problem of interviewer ease of use of criteria, and this solution has been tested in three prospective studies. It consists of a comprehensive implementation designed by Gastfriend and his associates to offer the counselor a sequence of questions and scoring options on the screen of a microcomputer (Turner, Turner et al., 1999).

There have been two naturalistic studies and one randomized controlled trial of placement criteria (the results of which are not yet published). Overall, the early studies have shown adequate reliability, good concurrent validity, and some degree of predictive validity (Gastfriend, Lu et al., 2000).

 

Conclusions

Four important missions underlie the ASAM criteria: (1) to enable patients to receive the most appropriate and highest quality treatment services, (2) to encourage the development of a broad continuum of care, (3) to promote the effective, efficient use of care resources, and (4) to help protect access to and funding for care. The use of placement criteria in treatment planning thus represents far more than a narrow utilization review or case management process. Correctly applied and implemented, the ASAM criteria can assist in improving the “placement match” by redesigning the place of treatment and the level of care.

Effective implementation of the newest version of the ASAM criteria (ASAM PPC-2R) will require a shift in thinking toward outcomes-driven case management. A variety of treatment agencies will need to make this shift, including regulatory agencies, clinical and medical staff, and referral sources (such as courts, probation officers, child protective services, employers, and employee assistance professionals (Heatherton, 2000).

The ASAM criteria offer a system for improving the “modality match” through the use of multidimensional assessment and treatment planning that permits more objective evaluation of patient outcomes. With improved outcome analysis driving treatment decisions, the problem of access to care and funding of treatment can be championed more effectively.

 

 

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TABLE 1.

Matching Patients with Co-Occurring Disorders to Services

 

 

SOURCE: Mee-Lee D, Shulman GD, Fishman M et al. (2001). ASAM Patient Placement Criteria for the Treatment of Substance Related Disorders, Second Edition-Revised (ASAM PPC-2R). Chevy Chase , MD : American Society of Addiction Medicine.