Use of ASAM PPC: Data from a National Sample of Addiction Treatment Programs

1. Use of ASAM PPC: Data from a National Sample of Addiction Treatment Programs J. Aaron Johnson, PhD The University of Georgia *Supported by the National Institute on Drug Abuse (R01-DA-13110, R01-DA-14482) The University of Georgia

2. Research Questions • To what extent have treatment centers in the US implemented the ASAM PPC? • How does implementation of ASAM PPC differ across different types of programs? • What are the characteristics of programs using ASAM PPC? The University of Georgia

3. Background • ASAM Patient Placement Criteria • developed in 1991 • Based on 1987 NAATP criteria and Cleveland Criteria • Current version is PPC2R, adopted in 2001 The University of Georgia

4. Previous Research • Gastfriend et al. - 1995-96 National Treatment Center Study Data • N = 400 Private Centers • 70% report adoption of ASAM PPC • Predictors of adoption include: offering multiple levels of care, managed care patients, co-occurring disorders, non-rural, region of the country • Only four years after PPC developed The University of Georgia

5. Previous Research (Survival) The University of Georgia

6. Methods • 2002-2003 National Treatment Center Study • N = 763 Addiction Treatment Programs • Sample includes for-profit, non-profit, and government-owned treatment centers; hospital-based and freestanding units; inpatient, outpatient, and mixed modalities. • Samples are differentiated by funding source. “Public” programs receive 50% or more of annual operating revenues from government grants or contracts; “private” centers receive <50%. • Sample excludes counselors in private practice, DUI programs, halfway houses, and methadone-only programs. • On-site interviews with program administrator The University of Georgia

7. Use of ASAM PPC by Program Type (%) The University of Georgia

8. Results: Multivariate Logistic Regression(See Handout) • Predictors of ASAM PPC use include: • Having a physician on staff • Offering Gender specific treatment • Use of ASI • % of clients with alcoholism as primary diagnosis • % revenues from block grants • Either JCAHO or CARF accreditation The University of Georgia

9. Telephone Follow-up • Conducted with sample of public and private programs 12-months after on-site visit • Several sections including section of 10 questions asking more about use of ASAM PPC • Questions were collaboration between UGA and CTN TMIG The University of Georgia

10. Familiarity with ASAM PPC(% Very Familiar) The University of Georgia

11. ASAM PPC Required by Principal Funder The University of Georgia

12. Computerized Scoring Software The University of Georgia

13. Summary • ASAM PPC higher in private programs compared to public programs • Private/public difference disappears in multi-variate model • Familiarity with ASAM PPC may partially explain difference • Private programs: Higher prevalence of physicians • Use of ASAM PPC in public programs - driven by funding requirements • Public programs more likely to use computerized version of ASAM PPC. • Likely necessary to meet reporting requirements of funding source The University of Georgia

14. Conclusions • Widespread adoption in U.S. implies a national standard model for placement • The clinical structure, funding from state/federal sources and being accredited by JCAHO or CARF increases likelihood of using ASAM PPC • Findings indicative of programs dedicated to: • Meeting quality standards/ quality improvement • use of best practices • standardization of treatment process • Public health implication: good potential for advancing treatment if can be standardized The University of Georgia

15. Limitations • Fidelity Issues • Sensitization during telephone follow-up • Mean across all programs = 62% (Range = 59% Govt-owned to 70% Private for profit) • States may use own modification of ASAM criteria The University of Georgia