An initial evaluation of the psychosocial dimensions of the American Society of Addiction Medicine criteria for inpatient versus intensive outpatient substance abuse rehabilitation

Abstract

Objective: The American Society of Addiction Medicine (ASAM) criteria were developed as guidelines for the placement of substance abuse patients in appropriate levels of care. Although the ASAM criteria are widely used, little is known about their validity. In this study, we evaluated the predictive validity of the psychosocial dimensions of the ASAM criteria for inpatient versus intensive outpatient rehabilitation.

Method: The psychosocial dimensions of the ASAM criteria were first operationalized with instruments with proven reliability and validity. The criteria were then used to determine whether cocaine (n = 159) and alcohol (n = 133) dependent male patients in inpatient and intensive outpatient rehabilitation programs were correctly "matched" to the level of care they received. The patients were followed up at 3, 6 and 12 months postrehabilitation, and outcomes of "matched" and "mismatched" patients were compared in a number of ways.

Results: Alcohol and cocaine patients who were correctly matched to treatment according to ASAM did not have significantly better outcomes than those who were mismatched. Furthermore, a more focused analysis generated no evidence that alcohol patients who met ASAM criteria for inpatient care had better outcomes in that setting than in intensive outpatient treatment. Among cocaine patients who met ASAM inpatient criteria, inpatient care produced marginally better short-term outcomes on most measures, although these results did not reach statistical significance.

Conclusions: These results suggest that the psychosocial dimensions of the ASAM criteria for inpatient treatment are probably too broad and are therefore in need of further refinement, particularly for alcohol patients. However, all patients were male veterans without acute medical problems serious enough to warrant inpatient care or histories of psychosis, and the majority were of lower socioeconomic status. It is not clear to what extent the results would generalize to substance abusers with other characteristics.