Matching patients with substance use disorder to optimal level of care with the ASAM Criteria software

Abstract

Great variation in assessment across Norwegian addiction programs necessitated a solution for harmonization. The American Society of Addiction Medicine (ASAM) Criteria Software is a computer-assisted structured interview and clinical decision support program. Using validated tools (e.g. Addiction Severity Index; ASI), it measures biopsychosocial conditions to match patients to an optimal level of care (LOC). Methods: This prospective, 10-site, double-blind study assessed a convenience sample of eligible treatment-seekers with substance use disorders in central Norway at intake (n = 261) and three months after naturalistic LOC placement (n = 153) on: (1) retention, (2) severity on seven ASI Composite Subscale Scores (controlling for differential dropout and baseline values) and (3) readiness for step-down care. Results: Retention differed significantly across groups and was lowest with under-matching vs. matching/over-matching (45% vs. 62% vs. 70%, p = 0.024). Matched patients reported less month-3 vs. baseline alcohol (p < 0.05) and cannabis (p < 0.05) use vs. no significant reductions with under-matching. ASI Composite Scores fell with matching on six of seven scales, two of seven with under-matching and three of seven with over-matching. Percent of patients per group ready to step-down to lower LOC was: 46% under-matched, 61% matched and 17% over-matched. Conclusions: Although more research is needed. The ASAM Criteria Software demonstrates predictive validity using all three prospectively planned measures.

• ASAM criteria
• assessment
• level of care
• substance use disorder
• treatment

Acknowledgements

The authors thank the clinics and ASAM assessors at the 10 treatment centers for their valuable assistance with recruitment and patient interviews.

Declaration of interest

This study was funded by the Norwegian Directorate of Health and Drug and Alcohol Addiction in Central Norway Trust (Helsedirektoratet, Rusbehandling Midt-Norge now reorganized under St. Olav's University Hospital, Clinic of Substance Use and Addiction Medicine, R & D department). The ASAM PPC-2R Assessment Software was licensed from the American Society of Addiction Medicine. Certified training and software consulting were provided under contract from RecoverySearch, Inc., Newton, MA, USA.

Marianne Stallvik reports no financial relationships with commercial interests. Dr. David R. Gastfriend is President and CEO of RecoverySearch Inc. and was contracted for training and scientific participation by Drug and Alcohol Treatment in Central Norway Trust (Rusbehandling Midt-Norge). Hans M. Nordahl reports no financial relationships with commercial interests. None of the authors have any additional income to report. Other than the foregoing acknowledgements, the source of funding had no role in the design, collection, analysis or interpretation of the data, development of the manuscript or the decision to submit the manuscript for publication.