LEVELS OF CARE AND OUTCOMES IN ALCOHOLISM TREATMENT

National Development &Res Institutes, New York NY

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Abstract

APPLICANT'S ABSTRACT: There is little research on the feasibility, outcomes and cost-effectiveness of using uniform patient placement criteria to match the type and intensity of alcoholism treatment to the individual needs of patients. The aims of the study are: 1. To determine the outcomes of implementing the American Society of Addiction Medicine (ASAM) Patient Placement Criteria in a multi-modality alcoholism treatment program. The study will compare outcomes for patients receiving the ASAM-recommended Level of Care ("matches") with outcomes for patients not receiving the recommended Level of Care ("mismatches"). Only patients mismatched due to external constraints will be included in the study; patients self-selecting their treatment will be excluded. 2. To determine the cost-effectiveness of implementing the ASAM Patient Placement Criteria, by comparing treatment costs and outcomes for matched vs. mismatched patients. 3. To examine the long-term aspects of alcoholism treatment utilization and recovery processes using longitudinal research. It is hypothesized that specific pre-treatment and treatment process variables will predict outcomes independently of ASAM Level of Care match and continuity of care. 4. Based on these results, to develop recommendations for revising the ASAM Patient Placement Criteria. The method will be a prospective longitudinal study of 320 alcohol-dependent patients (120 matched, 200 mismatched) admitted to a multi-modality treatment program Three Levels of Care characterized by substantial numbers of mismatches will be assessed: Level III (residential rehabilitation), Level II ( intensive outpatient), and Level I (regular outpatient or aftercare). Primary outcomes assessed at 3 and 12 month follow-ups will be alcohol/drug use and consequences, employment, psychological status, legal involvement. The independent and joint effects of pretreatment and treatment process variables (e.g., psychiatric comorbidity, reimbursement mode, stage of recovery, therapeutic alliance, appropriateness of Level of Care, continuity of care, intensity of treatment, specific services ) on patient outcomes will be determined. Using treatment cost data and outcome results, a cost-effectiveness analysis of matching and mismatching at different Levels of Care will be conducted.