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Addiction Treatment Progress and Obstacles: Page 4 of 4

Addiction Treatment Progress and Obstacles: Page 4 of 4

David Gastfriend, M.D., assistant professor of psychiatry at Massachusetts General Hospital and co-chair of the 2001 ASAM conference, discussed treatment-placement considerations. He distinguished between the matching of patients with an optimal theoretical treatment modality, as evaluated in Project MATCH, and placement matching for the least restrictive setting and resource intensity.

Criteria for placement match have been developed by ASAM, Gastfriend noted, and relate patient requirements to such treatment factors as hours of supervision and presence of medical and other specialties.

Despite progress in determining appropriate matches, Gastfriend et al. (2000) reported difficulty in implementing the solutions in the market-driven system of services reimbursement within the United States:

To solve many of these problems, it will be necessary in the future to move from a model in which levels of care are predetermined and patient's needs are clustered to fit these criteria, to a patient-based model in which patient assessment is the starting point for determining the optimal service to provide.

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References

References
1. DiClemente CC (1999), Motivation for change: implications for substance abuse treatment. Psychological Science 10:209-213.
2. Fuller RK, Gordis E (2001), Naltrexone treatment for alcohol dependence. N Engl J Med 345(24):1770-1771 [letter].
3. Gastfriend DR, Lu SH, Sharon E (2000), Placement matching: challenges and technical progress. Subst Use Misuse 35(12-14):2191-2213.
4. Krystal JH, Cramer JA, Krol WF et al. (2001), Naltrexone in the treatment of alcohol dependence. N Engl J Med 345(24):1734-1739.
5. Littleton J, Mayer S (1999), Acamprosate and alcohol dependence: another glimmer of hope? Presented at the ASAM State of the Art Conference. Washington, D.C., Nov. 5.
6. Petry NM, Petrakis I, Trevisan L et al. (2001), Contingency management interventions: from research to practice. Am J Psychiatry; 158(5):694-702.
7. Sturm R (2001), The Costs of Covering Mental Health and Substance Abuse Care at the Same Level As Medical Care in Private Insurance Plans. Testimony presented to the Health Insurance Committee at the National Conference of Insurance Legislators. Chicago; July 13.
 
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