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Drymalski WM, Nunley MR. Sensitivity of the ASAM Criteria to Psychiatric Need. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-017-9801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Drymalski WM. Expanding the use of the ASAM Criteria TM to make mental health level of care placements. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-10-2017-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite the prevalence of co-occurring mental health and substance use disorders, the assessment and placement processes for each often remain separate. The purpose of this paper is to describe an expanded use of the American Society of Addiction Medicine (ASAM) CriteriaTM to make placements into substance use, co-occurring, and mental health treatment.
Design/methodology/approach
A rationale for the development of two new domains (Domain 7, substance use and Domain 8, independent living skills) and preliminary data supporting the use of the ASAM CriteriaTM as a placement process for all types of behavioral health issues will be provided.
Findings
Dimension 3 and Domains 7 and 8 were correlated with selected clinical indices in the expected direction (Dimension 3: depression (F (4, 4650)=202.092, p<0.001), medication usage (F (4, 4,637)=174.254, p<0.001), and psychotic symptoms (F (4, 4,561)=62.954, p<0.001); Domain 7: alcohol use (F (4, 4,458)=213.786, p<0.001) and drug use (F (4, 4,471)=611.491, p<0.001); and Domain 8: functional impairment (F (4, 3,927)=815.646, p<0.001) and number of “high needs” (F (4, 3,927)=737.568, p<0.001).
Research limitations/implications
The limitations of this research included a lack of inter-rater reliability data and less established intake assessments.
Practical implications
This single placement approach for clients seeking behavioral health services can create a more efficient, person-centered intake experience.
Originality/value
This paper suggests that it is possible to deploy a single assessment and placement approach for all types of behavioral health issues.
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Schoenthaler SJ, Blum K, Fried L, Oscar-Berman M, Giordano J, Modestino EJ, Badgaiyan R. The effects of residential dual diagnosis treatment on alcohol abuse. ACTA ACUST UNITED AC 2017; 3. [PMID: 28868159 PMCID: PMC5576155 DOI: 10.15761/jsin.1000169] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This multi-center study of dual diagnosis (DD) programs involved 804 residential patients with co-occurring alcohol and mental health disorders. The Addiction Severity Index was administered at admission and at one, six, and 12 months after discharge. Repeated measures analysis showed the intoxication rate per month stabilized between months six and 12 with 68% still in remission and an 88% mean reduction from baseline (F = 519, p < .005). A comparison between patients with and without weekly relapse produced significant differences in hospitalization (odds ratio 11.3:1; 95% C.I., 5.5 to 23.2). Eight ANCOVAs used mean intoxication days per month after discharge as the outcome variable, pre-admission intoxication days per month as a covariate, and eight variables associated with relapse (e.g. depression) as factors. Patients with these factors at admission did not have significantly higher intoxication rates after discharge than patients without them. This suggests that these DD programs successfully integrated treatment of both disorders and explained their effectiveness. Co-occurring DSM IV mood disorders such as anxiety and depression as well as drug abuse involving opioids or cocaine fell between 66 and 95% at months one, six, and twelve.
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Affiliation(s)
| | - Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.,Dominion Diagnostics, LLC North Kingstown, RI, USA.,National Institute of Holistic Studies, North Miami Beach, FL, USA.,Department of Psychiatry, Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine Burlington, VT, USA.,Department of Addiction Research & Therapy, Nupathways, Innsbrook, MO, USA.,Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton OH, USA.,Department of Psychiatry, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.,Division of Addition Research & Therapy, The Shores Treatment & Recovery Center, Port St. Lucie, FL, USA.,Division of Precision Medicine, Geneus Health, LLC, San Antonio, TX, USA
| | - Lyle Fried
- Division of Addition Research & Therapy, The Shores Treatment & Recovery Center, Port St. Lucie, FL, USA
| | - Marlene Oscar-Berman
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, 02118, USA
| | - John Giordano
- National Institute of Holistic Studies, North Miami Beach, FL, USA
| | | | - Rajendra Badgaiyan
- Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton OH, USA
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A Technical Assistance Framework to Facilitate the Delivery of Integrated Behavioral Health Services in Federally Qualified Health Centers (FQHCs). J Subst Abuse Treat 2015; 60:62-9. [PMID: 26422450 DOI: 10.1016/j.jsat.2015.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 11/22/2022]
Abstract
An implementation approach, featuring direct, onsite technical assistance is described, and findings from a pilot study assessing the capability of Federally Qualified Health Centers to provide integrated behavioral health services are presented. Investigators used the Behavioral Health Integration in Medical Care (BHIMC) index to measure integration at baseline and follow-up at four FQHCs in New Jersey. Results indicate that the average baseline capability score of 1.95 increased to 2.44 at follow-up, almost one-half point on the five-point BHIMC index. This pilot project demonstrates that co-occurring capability can be assessed, and system-wide technical assistance can be delivered to assist FQHCs in integrating behavioral health services. Future research should test technical assistance as an implementation strategy to promote the integration of medical care and behavioral health treatment on a wider scale.
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Blanco C, Iza M, Rodríguez-Fernández JM, Baca-García E, Wang S, Olfson M. Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug Alcohol Depend 2015; 149:136-44. [PMID: 25725934 PMCID: PMC4789763 DOI: 10.1016/j.drugalcdep.2015.01.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about to what extent treatment-seeking behavior varies across individuals with alcohol abuse, alcohol dependence, drug abuse, and drug dependence. METHODS The sample included respondents from the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who reported a lifetime diagnosis alcohol abuse, alcohol dependence, drug abuse, or drug dependence. Unadjusted and adjusted hazard ratios are presented for time to first treatment contact by sociodemographic characteristics and comorbid psychiatric disorders. Individuals were censored from the analyses if their condition remitted prior to seeking treatment. RESULTS In the first year after disorder onset, rates of treatment-seeking were 13% for drug dependence, 5% for alcohol dependence, 2% for drug abuse, and 1% for alcohol abuse. The lifetime probability of seeking treatment among individuals who did not remit was also highest for drug dependence (90%), followed by drug abuse (60%), alcohol dependence (54%), and alcohol abuse (16%). Having had previous treatment contact for a substance use disorder (SUD) increased the probability of seeking treatment for another SUD. By contrast, an early age of SUD onset, belonging to an older cohort, and a higher level of education decreased the lifetime probability of treatment contact for SUD. The role of comorbid mental disorders was more complex, with some disorders increasing and other decreasing the probability of seeking treatment. CONCLUSIONS Given high rates of SUD and their substantial health and economic burden, these patterns suggest the need for innovative approaches to increase treatment access for individuals with SUD.
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Affiliation(s)
- Carlos Blanco
- New York State Psychiatric Institute, New York, NY, USA.
| | - Miren Iza
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | | | - Enrique Baca-García
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | - Shuai Wang
- New York State Psychiatric Institute, New York, NY, USA
| | - Mark Olfson
- New York State Psychiatric Institute, New York, NY, USA
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Stallvik M, Gastfriend DR, Nordahl HM. Matching patients with substance use disorder to optimal level of care with the ASAM Criteria software. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.934305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McGovern MP, Lambert-Harris C, Gotham HJ, Claus RE, Xie H. Dual diagnosis capability in mental health and addiction treatment services: an assessment of programs across multiple state systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:205-14. [PMID: 23183873 PMCID: PMC3594447 DOI: 10.1007/s10488-012-0449-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the dual diagnosis capability in addiction treatment and dual diagnosis capability in mental health treatment indexes, and sampled 256 programs across the United States. Approximately 18 % of addiction treatment and 9 % of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures.
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Affiliation(s)
- Mark P McGovern
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA,
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Abstract
OBJECTIVE The complexity of substance use and psychiatric disorders demands thorough assessment of patients for integrated services. We tested the convergent validity of the software version of the American Society of Addiction Medicine (ASAM) second edition-revised criteria for patient placement by examining the software's ability to discriminate based on a variety of demographic and clinical factors. METHODS This prospective naturalistic multi-site study examined the software's assignment of patients to three types of treatment (addiction only services, dual diagnosis capable, and dual diagnosis enhanced) and whether these assignments indicated an ability to discriminate between patients with and without dual diagnosis based on clinical characteristics and severity. Ten addiction treatment clinics spanning three counties participated, and both patients and ASAM assessors were kept blind to the ASAM recommendation. Patients were assigned to their respective treatment options based on routine assessment by clinicians at intake, which they had in addition to the ASAM interview. Three months after treatment initiation a follow-up interview with ASAM was conducted. RESULTS There were 261 patients in the study, 96 (36.7%) were assigned to addiction only services, 42 (16.1%) to dual diagnosis capable, and 123 (47.1%) to dual diagnosis enhanced. Patients assigned to the two dual diagnosis groups were significantly more likely to be younger and have fewer years of work than other patients. There were significant differences in history of inpatient and outpatient psychiatric treatment across groups. For example, a larger percentage of those in addiction only services had never been in inpatient treatment, while more of those in the two dual diagnosis groups had three or more inpatient stays. Despite similar alcohol and drug severity scores, patients recommended by the software for dual diagnosis enhanced programs showed a gradient of significantly higher psychiatric (p <.001), legal (p <.04), and family (p <.001) Addiction Severity Index composite scores at baseline than patients in dual diagnosis capable and addiction only services. CONCLUSIONS RESULTS show a high prevalence of co-occurring program recommendations with statistically significant and clinically meaningful differences between patient groups. The convergent validity of the revised version of ASAM Criteria Software is supported by these results.
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Affiliation(s)
- Marianne Stallvik
- a St.Olav's University Hospital , Clinic of Substance Use and Addiction Medicine, R & D Department , Trondheim , Norway
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Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units. J Addict Med 2013; 3:139-50. [PMID: 21769010 DOI: 10.1097/adm.0b013e31818ebb6f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Standardized patient placement criteria such as those developed by the American Society of Addiction Medicine are increasingly common in substance abuse treatment, but it is unclear what factors are associated with their use or with treatment units' provision of related services. This study examined these issues in the context of a national survey of outpatient substance abuse treatment units. Regressions using 2005 data revealed that both public and private managed care were associated with a greater likelihood of using American Society of Addiction Medicine criteria to develop client treatment plans. However, only public managed care was associated with a greater likelihood of offering more resource-intensive services. Associations between client population severity and resource-intensive service provision were sparse but positive.
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10
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Organizational capacity to address co-occurring substance use and psychiatric disorders: assessing variation by level of care. J Addict Med 2013. [PMID: 23188042 DOI: 10.1097/adm.0b013e318276e7a4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is widespread recognition that services to persons with co-occurring substance use and psychiatric disorders should be accessible, yet most persons with these disorders do not receive care for both problems. Estimates of available services vary widely and have not examined potential variation by level of care. METHODS The present study samples 180 community addiction treatment programs and utilizes a standardized observational assessment of these programs using the dual diagnosis capability of addiction treatment (DDCAT) index. By level of care, the sample consisted of 53 outpatient programs, 50 intensive outpatient programs, and 77 residential programs. RESULTS Overall, approximately 81.1% of programs across levels of care offered addiction-only services, 18.3% dual diagnosis capable services, and less than 1% dual diagnosis enhanced services. Relative to residential and intensive outpatient programs, outpatient programs were more likely to have greater dual diagnosis capability (dual diagnosis capable services). Outpatient programs scored significantly higher on the DDCAT dimensions associated with program policies and continuity of care. Specific DDCAT benchmark items revealing detailed differences were found in these dimensions and specific assessment and treatment practices. Access to physician-prescriber or to psychotropic medications did not differ by level of care. CONCLUSIONS The findings suggest that across levels of care, addiction-treatment systems and programs must continue to improve capacity for patients with co-occurring disorders. The application of a standardized, objective, and observational instrument may be useful to guide and measure the effectiveness of these efforts.
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McGovern MP, Urada D, Lambert-Harris C, Sullivan ST, Mazade NA. Development and initial feasibility of an organizational measure of behavioral health integration in medical care settings. J Subst Abuse Treat 2012; 43:402-9. [PMID: 22999813 DOI: 10.1016/j.jsat.2012.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 08/02/2012] [Accepted: 08/09/2012] [Indexed: 11/18/2022]
Abstract
In the advent of health care reform, models are sought to integrate behavioral health and routine medical care services. Historically, the behavioral health specialty has not itself been integrated, but instead bifurcated by substance use and mental health across treatment systems, care providers and even research. With the present opportunity to transform the health care delivery system, it is incumbent upon policymakers, researchers and clinicians to avoid repeating this historical error, and provide integrated behavioral health services in medical contexts. An organizational measure designed to assess this capacity is described: the Dual Diagnosis Capability in Health Care Settings (DDCHCS). The DDCHCS was used to assess a sample of federally-qualified health centers (N=13) on the degree of behavioral health integration. The measure was found to be feasible and sensitive to detecting variation in integrated behavioral health services capacity. Three of the 13 agencies were dual diagnosis capable, with significant variation in DDCHCS dimensions measuring staffing, treatment practices and program milieu. In general, mental health services were more integrated than substance use. Future research should consider a revised version of the measure, a larger and more representative sample, and linking organizational capacity with patient outcomes.
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Affiliation(s)
- Mark P McGovern
- Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire 03766, USA.
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Chuang E, Wells R, Alexander JA. Public managed care and service access in outpatient substance abuse treatment units. J Behav Health Serv Res 2012; 38:444-63. [PMID: 21184286 DOI: 10.1007/s11414-010-9230-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The continued growth of public managed behavioral health care has raised concerns about possible effects on services provided. This study uses a national sample of outpatient substance abuse treatment units surveyed in 2005 to examine associations between public managed care and service access, measured as both the types of services provided and the amount of treatment received by clients. The percentage of clients funded through public managed care versus other types of public funding was positively associated with treatment units' odds of providing some types of resource-intensive services and with the odds of providing transportation to clients, but was negatively associated with the average number of individual therapy sessions clients received over the course of treatment. In general, public managed care does not appear to restrict access to outpatient substance abuse treatment, although states should monitor these contracts to ensure clients receive adequate courses of individual treatment.
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Affiliation(s)
- Emmeline Chuang
- Department of Mental Health Law and Policy, Department of Child and Family Studies, College of Behavioral and Community Studies, 13301 Bruce B Downs Blvd, Tampa, FL 33612-3807, USA.
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Kola LA, Kruszynski R. Adapting the Integrated Dual-Disorder Treatment Model for Addiction Services. ALCOHOLISM TREATMENT QUARTERLY 2010. [DOI: 10.1080/07347324.2010.511067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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