Matching patients with substance use disorder to optimal level of care with the ASAM Criteria software

Great variation in assessment across Norwegian addiction programs necessitated a solution for harmonization. The American Society of Addiction Medicine (ASAM) Criteria Software is a computer-assisted structured interview and clinical decision support program. Using validated tools (e.g. Addiction Severity Index; ASI), it measures biopsychosocial conditions to match patients to an optimal level of care (LOC). Methods: This prospective, 10-site, double-blind study assessed a convenience sample of eligible treatment-seekers with substance use disorders in central Norway at intake (n = 261) and three months after naturalistic LOC placement (n = 153) on: (1) retention, (2) severity on seven ASI Composite Subscale Scores (controlling for differential dropout and baseline values) and (3) readiness for step-down care. Results: Retention differed significantly across groups and was lowest with under-matching vs. matching/over-matching (45% vs. 62% vs. 70%, p = 0.024). Matched patients reported less month-3 vs. baseline alcohol (p < 0.05) and cannabis (p < 0.05) use vs. no significant reductions with under-matching. ASI Composite Scores fell with matching on six of seven scales, two of seven with under-matching and three of seven with over-matching. Percent of patients per group ready to step-down to lower LOC was: 46% under-matched, 61% matched and 17% over-matched. Conclusions: Although more research is needed. The ASAM Criteria Software demonstrates predictive validity using all three prospectively planned measures.