Retrospective evaluation of ASAM criteria in adolescents receiving weeklyoutpatient treatment for co-occurring psychiatric and substance use disorders
Beverly Holmes1, Louise Haynes2, Jeff Leimberger3, P.aula Riggs4
1Lexington-Richland Alcohol and Drug Abuse Council, 2Medical University of South Carolina,
3Duke Clinical Research Institute, 4University of Colorado, Denver
American Society of AddictionMedicine (ASAM) criteria arewidely used to determine levelof care/treatment intensity.However, there is a lack ofresearch on the validity ofASAM placement criteria inadolescents with co-occurringpsychiatric and substance usedisorders (SUD), who generallymeet ASAM criteria for moreintensive treatment. We couldfind no studies evaluatingwhether integrated treatmentapproaches for co-occurringdisorders might produce similaroutcomes to more intensive (andcostly) level of care. We presentpreliminary data addressing thisresearch gap.
18% (n=6/32) met ASAM Level 1criteria (outpatient); 40.5% (n=13/32)met ASAM Level 2 criteria (intensiveoutpatient); and 40.5% (n=13/32) metASAM Level 3 criteria (residential)(Figure 1).
Retrospective chart reviews wereconducted to determine ASAMplacement criteria in 32adolescents who participated in arandomized controlled trialOsmotic-ReleaseMethylphenidate (OROS-MPH)for attention deficit hyperactivitydisorder (ADHD) and substanceuse disorders (NIDA CTN 0028).
As shown in Figure 2, below, 100%of participants meeting ASAMLevel 1 completed 16 weeks oftreatment and were 80.3% compliantwith CBT session attendance. Ofparticipants meeting ASAM Level 2,76.9% completed 16 weeks oftreatment and were 70.7% CBTattendance compliant. Ofparticipants meeting ASAM Level 3,76.9% completed 16 weeks oftreatment and were 72.5% CBTattendance compliant. There were nostatistically significant differencesbetween groups in treatmentcompletion or CBT sessionattendance.
Treatment compliance and completion werehigher than expected given the severity ofsubstance abuse and psychopathology in thissample.
• Treatment outcomes were comparableacross all three groups despite the fact that82% of the sample would have been assignedto more intensive treatment based onretrospective determination of ASAMplacement criteria
• If replicated, results suggest that lessintensive integrated treatment approachesmay produce comparable outcomes to moreintensive (and more costly) treatmentapproaches (e.g. IOP, residential) foradolescents with co-occurring psychiatric andsubstance use disorders.
• More research is needed on the validity ofASAM placement criteria in adolescents withco-occurring psychiatric and substance usedisorders.
Supported by NIDA U10DA13727
Figure 1: ASAM placement criteria based onretrospective chart review
Figure 2. Treatment Completion and Compliance withCBT Session Attendance
Similarly there was not a statisticallysignificant difference in reduction indays of past 28-day drug use betweenASAM Levels 1 (-1.0 day), 2 (-3.7days), or 3 (-0.7 days).
Figure 3. Baseline demographics and clinical characteristics
Background
Methods
Methods (Continued)
Results
Results (Continued)
Conclusion
Acknowledgements
All participants received individualweekly outpatient cognitivebehavioral therapy (CBT) forsubstance abuse throughout the 16week medication trial. Allparticipants met DSM-IV diagnosticcriteria for ADHD and at least onenon-tobacco SUD. Participantsmeeting criteria for ASAM Level 1(outpatient treatment), ASAM Level2 (intensive outpatient) and ASAMLevel 3 (residential treatment) werecompared on treatment outcomemeasures including: 1. treatmentcompletion; 2. treatment compliance(CBT session attendance); and 3.substance use.