Predictive Validity of the ASAM Patient Placement Criteria for Naturalistically Matched vs. Mismatched Alcoholism Patients

Authors

  • Stephen Magura Ph.D., C.S.W.,

    Corresponding author
    1. The Institute for Treatment and Services Research at National Development and Research Institutes (NDRI), New York, NY
    Search for more papers by this author
  • Graham Staines Ph.D.,

    1. The Institute for Treatment and Services Research at National Development and Research Institutes (NDRI), New York, NY
    Search for more papers by this author
  • Nicole Kosanke Ph.D.,

    1. The Institute for Treatment and Services Research at National Development and Research Institutes (NDRI), New York, NY
    Search for more papers by this author
  • Andrew Rosenblum Ph.D.,

    1. The Institute for Treatment and Services Research at National Development and Research Institutes (NDRI), New York, NY
    Search for more papers by this author
  • Jeffrey Foote Ph.D.,

    1. The Smithers Treatment Center, St. Lukes-Roosevelt Medical Center, New York, NY
    2. Dr. Foote is currently at the National Center on Addiction and Substance Abuse at Columbia University, New York, NY
    Search for more papers by this author
  • Alexander DeLuca M.D.,

    1. The Smithers Treatment Center, St. Lukes-Roosevelt Medical Center, New York, NY
    2. Dr. DeLuca is currently in private practice in New York, NY
    Search for more papers by this author
  • Priti Bali B.A.

    1. The Institute for Treatment and Services Research at National Development and Research Institutes (NDRI), New York, NY
    Search for more papers by this author

  • Presented in part at the American Society of Addiction Medicine (ASAM) 31st Annual Medical-Scientific Conference, Chicago, Il., April 15, 2000.

Address correspondence to Dr. Magura, NDRI, 71 West 23rd St., New York, NY 10010. E-mail: magura@ndri.org.

Abstract

This study examined the predictive validity of the ASAM Patient Placement Criteria for matching alcoholism patients to recommended levels of care. A cohort of 248 patients newly admitted to inpatient rehabilitation, intensive outpatient, or regular outpatient care was evaluated using both a computerized algorithm and a clinical evaluation protocol to determine whether they were naturalistically matched or mismatched to care. Outcomes were assessed three months after intake. One common type of undertreatment (ie, receiving regular outpatient care when intensive outpatient care was recommended) predicted poorer drinking out comes. As compared with matched treatment, independent of actual level of care received. Overtreatment did not improve outcomes. There also was a trend for better outcomes with residential vs. intensive outpatient treatment, independent of matching. Results were robust for both methods of assessment. Corroboration by more research is needed, but the ASAM Criteria show promise for reducing both detrimental undertreatment and cost-inefficient overtreatment.

Ancillary