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Retrospective evaluation of ASAM criteria in adolescents receiving weekly
outpatient treatment for co-occurring psychiatric and substance use disorders
Beverly
1
Holmes ,
Louise
2
Haynes ,
1Lexington-Richland Alcohol
Jeff
3
Leimberger ,
P.aula
4
Riggs
2Medical
and Drug Abuse Council,
University of South Carolina,
3Duke Clinical Research Institute, 4University of Colorado, Denver
Background
Methods (Continued)
Results (Continued)
American Society of Addiction
Medicine (ASAM) criteria are
widely used to determine level
of care/treatment intensity.
However, there is a lack of
research on the validity of
ASAM placement criteria in
adolescents with co-occurring
psychiatric and substance use
disorders (SUD), who generally
meet ASAM criteria for more
intensive treatment. We could
find no studies evaluating
whether integrated treatment
approaches for co-occurring
disorders might produce similar
outcomes to more intensive (and
costly) level of care. We present
preliminary data addressing this
research gap.
All participants received individual
weekly outpatient cognitive
behavioral therapy (CBT) for
substance abuse throughout the 16
week medication trial. All
participants met DSM-IV diagnostic
criteria for ADHD and at least one
non-tobacco SUD. Participants
meeting criteria for ASAM Level 1
(outpatient treatment), ASAM Level
2 (intensive outpatient) and ASAM
Level 3 (residential treatment) were
compared on treatment outcome
measures including: 1. treatment
completion; 2. treatment compliance
(CBT session attendance); and 3.
substance use.
As shown in Figure 2, below, 100%
of participants meeting ASAM
Level 1 completed 16 weeks of
treatment and were 80.3% compliant
with CBT session attendance. Of
participants meeting ASAM Level 2,
76.9% completed 16 weeks of
treatment and were 70.7% CBT
attendance compliant. Of
participants meeting ASAM Level 3,
76.9% completed 16 weeks of
treatment and were 72.5% CBT
attendance compliant. There were no
statistically significant differences
between groups in treatment
completion or CBT session
attendance.
80%
70%
60%
50%
40%
30%
Figure 1: ASAM placement criteria based on
retrospective chart review
20%
10%
0%
Treatment Completion
CBT Compliance
N=6
Similarly there was not a statistically
significant difference in reduction in
days of past 28-day drug use between
ASAM Levels 1 (-1.0 day), 2 (-3.7
days), or 3 (-0.7 days).
N=13
N-13
-500.0%
Conclusion
Treatment compliance and completion were
higher than expected given the severity of
substance abuse and psychopathology in this
sample.
• Treatment outcomes were comparable
across all three groups despite the fact that
82% of the sample would have been assigned
to more intensive treatment based on
retrospective determination of ASAM
placement criteria
• If replicated, results suggest that less
intensive integrated treatment approaches
may produce comparable outcomes to more
intensive (and more costly) treatment
approaches (e.g. IOP, residential) for
adolescents with co-occurring psychiatric and
substance use disorders.
• More research is needed on the validity of
ASAM placement criteria in adolescents with
co-occurring psychiatric and substance use
disorders.
Acknowledgements
Supported by NIDA U10DA13727
ASAM Level 1
ASAM Level 2
ASAM Level 3
Conduct disorder
ASAM Level 3
0.0%
substance use days chg from baseline to week 16
ASAM Level 2
90%
500.0%
# days substance use pre-treatment
ASAM Level 1
1000.0%
Mean #substance abuse/dep diagnoses from CIDI
100%
1500.0%
Mean Age
conducted to determine ASAM
placement criteria in 32
adolescents who participated in a
randomized controlled trial
Osmotic-Release
Methylphenidate (OROS-MPH)
for attention deficit hyperactivity
disorder (ADHD) and substance
use disorders (NIDA CTN 0028).
18% (n=6/32) met ASAM Level 1
criteria (outpatient); 40.5% (n=13/32)
met ASAM Level 2 criteria (intensive
outpatient); and 40.5% (n=13/32) met
ASAM Level 3 criteria (residential)
(Figure 1).
ASAM Level 1
ASAM Level 2
ASAM Level 3
Females
Retrospective chart reviews were
Figure 2. Treatment Completion and Compliance with
CBT Session Attendance
2000.0%
Males
Methods
Results
Figure 3. Baseline demographics and clinical characteristics