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The Department of Defense last month adopted "placement criteria" for the treatment of substance abuse disorders among members of the armed forces and their dependents.
The criteria, developed by the American Society of Addiction Medicine to match level of care with a patient's specific needs, will be used throughout the armed services for the more than 6 million active-duty personnel and their dependents.
The ASAM first developed the criteria in 1991. The second edition of the criteria, which the DoD adopted, was published last year.
Stephen C. Joseph, M.D., assistant secretary of defense for health affairs at the Department of Defense, stated in a memorandum last month that the criteria adopted by DoD will "reflect the philosophy of placing patients in the least-restrictive treatment environment, appropriate to their therapeutic needs.
"Variable lengths of stay [and] duration of treatment shall be provided within a variety of treatment settings," Joseph said.
Psychiatrist David Mee-Lee, M.D., chair of ASAM's criteria committee, explained that the placement criteria are far different from practice guidelines in that they are used to determine the level of treatment intensity needed by a specific patient with a diagnosis of a substance abuse disorder.
The criteria use the diagnostic terminology of APA's DSM-IV, Mee-Lee said.
Mee-Lee said the placement criteria include six dimensions by which to look at a patient's functioning and match the patient with a level of treatment:
"By looking at each of these dimensions, you can get a total functioning and total severity profile," said Mee-Lee, who will be teaching a course on treatment resistance at APA's annual meeting in San Diego later this month. "This provides a model for getting people to think more specifically about a person's individual needs."
Psychiatrist Sheila Blume, M.D., who is a consultant to APA's Council on Addiction Psychiatry and helped develop ASAM's criteria, said they can assist in providing structure and a degree of uniformity to the treatment of addictions, which has traditionally varied from provider to provider and from locality to locality.
James Callahan, D.P.A., executive director of ASAM, called the guidelines the "first nationally recognized guidelines for an objectively grounded determination of need for care and level of care."
Callahan noted that the criteria speak to two issues of importance in the treatment of addiction: quality of care and resource use. Callahan framed the two issues this way: "Are we providing the kind of care that is needed? And if we expend resources, is it necessary?"
Army Colonel Terry Schultz, a psychiatrist who serves as an alcohol and drug abuse consultant to the Army surgeon general and a DoD representative to the National Advisory Council on Drug Abuse, said the criteria "provide a way to. . .match the severity of the addiction with patient placement."
Schultz estimated that 1 percent to 2 percent of beneficiaries in the military have an addictive disorder, not including alcohol and tobacco. That figure is down from 5 percent to 6 percent in 1981, when the DoD instituted a urine-testing program, he said.
The ASAM criteria are available to ASAM members for $85 and to nonmembers for $100 by calling the ASAM Publications Distribution Center at (800) 844-8948.
(Psychiatric News, May 16, 1997)