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Chapter 6. Patient Placement Criteria

David Mee-Lee, M.D.; David R. Gastfriend, M.D.
DOI: 10.1176/appi.books.9781585623440.345322

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Excerpt

Patient placement criteria are decision rules that guide care providers and care managers in assigning patients to the optimal clinical and cost-effective level of care. Extensive reviews of the treatment outcome literature demonstrate that treatment for addictive disorders is effective, but that no single treatment model or level of care is appropriate for all individuals (Berglund et al. 2003; Institute of Medicine 1990; Miller et al. 2002; National Institute on Drug Abuse 1999). However, most programs still deliver services with one predominant ideological model, whether that model is abstinence-mandated, 12-step recovery; the Minnesota Model; harm reduction, opioid maintenance treatment; social model therapeutic communities; behavior therapy models; or psychiatric and mental health approaches. In addition, most treatment and funding systems still provide for only a limited continuum of care. This treatment and funding deficiency continues to occur despite the availability of detailed criteria for a broad array of service levels that has existed for over two decades.

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FIGURE 6–1. Matching assessment and treatment/placement.
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TABLE 6–1. Principles guiding American Society of Addiction Medicine Patient Placement Criteria development and implications
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TABLE 6–2. American Society of Addiction Medicine assessment dimensions
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TABLE 6–3. Matrix for matching services to needs
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Treatment outcome research demonstrates that treatment for addictive disorders is effective, but that no single model or level of care is appropriate for all individuals. The services themselves and where they are delivered should therefore be individualized to each patient's assessed needs.

The patient placement criteria incorporate multidimensional assessments of severity-of-illness and level-of-function; problem and priority identification; treatment matching of needs-to-services; and level-of-care placement within a broad continuum of care. Ongoing assessment of progress and treatment response determines movement to less or more intensive levels of care.

The most widely used and researched patient placement criteria tool for addiction treatment is the Patient Placement Criteria (PPC) for the Treatment of Substance-Related Disorders of the American Society of Addiction Medicine (ASAM). The most recent edition, published in 2001, includes criteria for people with co-occurring mental and substance use disorders.

The ASAM PPC describe a broad range of levels of care. Yet benefit plans, public funding, and provider programs are frequently restricted to a limited continuum of care, even though a broader range of options could provide longer lengths of care and monitoring using the same or even fewer resources.

More than a decade of research on the ASAM PPC supports the predictive validity and cost-effectiveness of the use of PPC. Based on this research, a variety of computer-assisted assessment and placement tools are in development.

References

Alterman AI, O'Brien CP, McLellen AT, et al: Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation. J Nerv Ment Dis 182:157–163, 1994
[PubMed]
 
American Society of Addiction Medicine: Patient Placement Criteria for the Treatment of Substance-Related Disorders: ASAM PPC-2, 2nd Edition. Chevy Chase, MD, American Society of Addiction Medicine, 1996
 
Angarita GA, Reif S, Pirard S, et al: No-show for treatment in substance abuse patients with comorbid symptomatology: validity results from a controlled trial of the ASAM Patient Placement Criteria. J Addict Med 1:79–87, 2007
 
Annis H: Patient-treatment matching in the management of alcoholism. NIDA Res Monogr 90:152–161, 1988
[PubMed]
 
Baker SL, Gastfriend DR: Reliability of multidimensional substance abuse treatment matching: implementing the ASAM Patient Placement Criteria. Journal of Addictive Disease 22 (suppl 1):45–60, 2003
 
Ball J, Ross A: The Effectiveness of Methadone Maintenance Treatment. New York, Springer-Verlag, 1991
 
Berglund M, Thelande, S, Jonsson E (eds): Treating Alcohol and Drug Abuse – An Evidence Based Review. Weinheim, Germany, Wiley-VCH Verlag, 2003
 
Book J, Harbin H, Marques C, et al: The ASAM and Green Spring alcohol and drug detoxification and rehabilitation criteria for utilization review. Am J Addict 4:187–197, 1995
 
Clinical Trials Network Bulletin. Treatment matching interest group. Vol 04–05, 4. March 10, 2004
 
Deck D, Gabriel R, Knudson J, et al: Impact of patient placement criteria on substance abuse treatment under the Oregon Health Plan. J Addict Dis 22 (suppl 1):27–44, 2003
 
Endicott J, Spitzer R, Fleiss JL, et al: The Global Assessment Scale: a procedure for measuring overall severity of psychiatric diagnosis. Arch Gen Psychiatry 33:766–773, 1976
[PubMed]
 
Fudala PJ, Berkow LC, Fralich JL, et al: Use of naloxone in the assessment of opiate dependence. Life Sci 49:1809–1814, 1991
[PubMed]
 
Gastfriend DR: Memo to the National Consortium on Patient Placement Criteria: The Cumulative Block Increment Model. Chevy Chase, MD, American Society of Addiction Medicine, 1994
 
Gastfriend DR: Placement criteria come of age. Paper presented at the annual medical-scientific meeting of the American Society of Addiction Medicine, Los Angeles, CA, April 20, 2001
 
Gastfriend DR, McLellan AT: Treatment matching: theoretic basis and practical implications. Med Clin North Am 81:945–966, 1997
[PubMed]
 
Gastfriend DR, Mee-Lee D: The ASAM patient placement criteria: context, concepts and continuing development. J Addict Dis 22 (suppl 1):1–8, 2003
 
Gastfriend DR, Baker SL, Najavits LM, et al: Assessment instruments, in Principles of Addiction Medicine. Edited by Miller N, Doot M. Chevy Chase, MD, American Society of Addiction Medicine, 1994, pp 1–8
 
Gastfriend DR, Filstead WJ, Reif S, et al: Validity of assessing treatment readiness in patients with substance use disorders. Am J Addict 4:254–260, 1995
 
Gastfriend DR, Lu SH, Sharon E: Placement matching: challenges and technical progress. Subst Use Misuse 35:2191–2213, 2000
[PubMed]
 
Hall R: Global assessment of functioning: a modified scale. Psychosomatics 36:267–275, 1995
[PubMed]
 
Hayashida M, Alterman AI, McLellan AT, et al: Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 320:358–365, 1989
[PubMed]
 
Hoffmann NG, Halikas J, Mee-Lee D: The Cleveland Admission, Discharge and Transfer Criteria: Model for Chemical Dependency Treatment Programs. Cleveland, OH, Northern Ohio Chemical Dependency Treatment Consortium, 1987
 
Hoffmann NG, Halikas J, Mee-Lee D, et al: American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders. Washington, DC, American Society of Addiction Medicine, 1991
 
Hser YI, Polinsky ML, Maglione M, et al: Matching clients' needs with drug treatment services. J Subst Abuse Treat 16:299–305, 1999
[PubMed]
 
Institute of Medicine: Broadening the Base of Treatment for Alcohol Problems: A Report of a Study by a Committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine. Washington, DC, National Academy Press, 1990
 
Institute of Medicine, Committee for Substance Abuse Coverage Study: Treating Drug Problems. Edited by Gerstein DR, Harwood HJ. Washington, DC, National Academy Press, 1990–1992
 
Joe GW, Simpson DD, Hubbard RL, et al: Treatment predictors of tenure in methadone maintenance. J Subst Abuse 3:73–84, 1991
[PubMed]
 
Kang SK, Sharon S, Pirard S, et al: Predictors for residential rehabilitation and treatment no-show in high frequency cocaine users: validation of the American Society of Addiction Medicine (ASAM) Criteria. Las Vegas, NV, American Academy of Addiction Psychiatrists, 2002
 
Litt M, Boca F, Cooney N: Matching Alcoholics to Aftercare Treatment by Empirical Clustering. Farmington, CT, University of Connecticut Health Center, 1989
 
Longabaugh R, Wirtz PW, DiClemente CC, et al: Issues in the development of client-treatment matching hypotheses. J Stud Alcohol Suppl 12:46–59, 1994
[PubMed]
 
Longabaugh R, Wirtz PW, Beattie MC, et al: Matching treatment focus to patient social investment and support: 18-month follow-up results. J Consult Clin Psychol 63:296–307, 1995
[PubMed]
 
Magura S, Staines GL, Kosanke N, et al: Predictive validity of the ASAM Patient Placement Criteria for naturalistically matched vs. mismatched alcohol-dependent patients. Am J Addict 12:386–397, 2003
[PubMed]
 
McKay JR, Cacciola JS, McLellan AT, et al: An initial evaluation of the psychosocial dimensions of the American Society of Addiction Medicine criteria for inpatient vs. intensive outpatient substance abuse rehabilitation. J Stud Alcohol 58:239–252, 1997
[PubMed]
 
McLellan AT, Woody GE, Luborsky L, et al: Increased effectiveness of substance abuse treatment: a prospective study of patient-treatment "matching". J Nerv Ment Dis 171:597–605, 1983a
 
McLellan AT, Woody GE, Luborsky L, et al: Predicting response to alcohol and drug abuse treatments. Arch Gen Psychiatry 40:620–625, 1983b
 
McLellan AT, Kushner H, Metzger DS, et al: The fifth edition of the Addiction Severity Index. J Subst Abuse Treat 9:199–213, 1992
[PubMed]
 
McLellan AT, Arndt IO, Metzger DS, et al: The effects of psychosocial services in substance abuse treatment. JAMA 269:1953–1959, 1993a
 
McLellan AT, Grissom GR, Brill P, et al: Private substance abuse treatments: are some programs more effective than others? J Subst Abuse Treat 10:243–254, 1993b
 
McLellan AT, Alterman A, Metzger DS, et al: Similarity of outcome predictors across opiate, cocaine and alcohol treatments: role of treatment services. J Clin Consult Psychol 62:1141–1158, 1994
[PubMed]
 
McLellan AT, Grissom GR, Zanis D, et al: Problem-service "matching" in addiction treatment: a prospective study in 4 programs. Arch Gen Psychiatry 54:730–735, 1997
[PubMed]
 
Mechanic D, Schlesinger M, McAlpine DD, et al: Management of mental health and substance abuse services: state of the art and early results. Milbank Q 73:19–55, 1995
[PubMed]
 
Mee-Lee D: An instrument for treatment progress and matching: the Recovery Attitude and Treatment Evaluator (RAATE). J Subst Abuse Treat 5:183–186, 1988
[PubMed]
 
Mee-Lee D: Use of patient placement criteria in the selection of treatment: overview of addiction treatment, in Principles of Addiction Medicine, 2nd Edition. Chevy Chase, MD, American Society of Addiction Medicine, 1998, pp 363–370
 
Mee-Lee D, Shulman GD: The ASAM Patient Placement Criteria and matching patients to treatment: overview of addiction treatment, in Principles of Addiction Medicine, 3rd Edition. Edited by Graham AW, Schultz TK, Mayo-Smith MF, et al. Chevy Chase, MD, American Society of Addiction Medicine, 2003, pp 453–465
 
Mee-Lee D, Hoffmann NG, Smith M: Recovery Attitude and Treatment Evaluator (RAATE) Manual. St Paul, MN, CATOR/New Standards, 1992
 
Mee-Lee D, Shulman GD, Fishman M, et al: ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders, 2nd Edition, Revised (ASAM PPC-2R). Chevy Chase, MD, American Society of Addiction Medicine, 2001
 
Miller WR, Hester RK: The effectiveness of alcoholism treatment: what research reveals, in Treating Addictive Behaviors: Processes of Change. Edited by Miller WR, Heather N. New York, Plenum, 1986, pp 121–174
 
Miller WR, Wilbourne PL, Hettema JE: What works? A summary of alcohol treatment outcome research, in Handbook of Alcoholism Treatment Approaches: Effective Alternatives. Edited by Hester RK, Miller WR. New York, Allyn and Bacon, 2002, pp 13–63
 
Miller WR, Zweben J, Johnson WR: Evidence-based treatment: why, what, where, when, and how? J Subst Abuse Treat 29:267–276, 2005
[PubMed]
 
Moos RH, Finney JW: Substance abuse treatment programs and processes: linkages to patients' needs and outcomes. J Subst Abuse 7:1–8, 1995
[PubMed]
 
Najavits LM, Gastfriend DR, Nakayama EY, et al: A measure of readiness for substance abuse treatment: psychometric properties of the RAATE research interview. Am J Addict 6:74–82, 1997
[PubMed]
 
National Institute on Drug Abuse: Principles of drug addiction treatment: a research-based guide (NIH Publ No 00–4180). Rockville, MD: National Institute on Drug Abuse, 1999
 
Plough AL, Shirley L, Zaremba N, et al: CSAT Target Cities Demonstration Final Evaluation Report, Boston Office for Treatment Improvement. Boston, MA, Massachusetts Bureau of Substance Abuse Services, 1996
 
Regier DA, Kaebler CT, Roper MT, et al: The ICD-10 clinical field trial for mental and behavioral disorders: results in Canada and the United States. Am J Psychiatry 151:1340–1350, 1994
[PubMed]
 
Sharon E, Krebs C, Turner W, et al: Predictive validity of the ASAM Patient Placement Criteria for hospital utilization. J Addict Dis 22 (suppl 1):79–93, 2003
 
Sullivan JT, Sykora K, Schneiderman J, et al: Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol Scale. Br J Addict 84:1353–1357, 1989
[PubMed]
 
Turner WM, Turner KH, Reif S, et al: Feasibility of multidimensional substance abuse treatment matching: automating the ASAM Patient Placement Criteria. Drug Alcohol Depend 55:35–43, 1999
[PubMed]
 
Weedman RD: Admission, Continued Stay and Discharge Criteria for Adult Alcoholism and Drug Dependence Treatment Services. Irvine, CA, National Association of Addiction Treatment Providers, 1987
 
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CME Activity

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Sample questions:
1.
Modality matching. . .
2.
Several important principles guided the development of the American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC). Which of the following is not one of these criteria?
3.
According to the ASAM criteria, there are five levels of care within which a later edition of the criteria indicate additional sublevels and modalities. Which level is designed to help the individual achieve permanent changes in his or her alcohol and drug-using behavior and mental functioning?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
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