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ASAM takes broader perspective, more user-friendly approach with new clinical criteria

June 5, 2013
by Gary A. Enos, Editor
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In everything from format to terminology, the new and long-awaited clinical criteria to be issued this fall from the American Society of Addiction Medicine (ASAM) will represent a significant change from the standards that were last updated in 2001. Yet the new ASAM Criteria also are meant to assist addiction professionals in fulfilling what their architect, David Mee-Lee, MD, has seen as their purpose from the start: not simply justifying insurance coverage decisions, but guiding truly patient-focused treatment.

“David would say that the role of the criteria is to support professionals in doing multidimensional assessments, and then to serve as ongoing support for patient-centered care,” says Penny S. Mills, ASAM’s executive vice president and CEO.

In that regard, ASAM’s existing Patient Placement Criteria (the medical society is dropping “Patient Placement” from the title of this year’s revision to reflect a more expansive view of their use) were falling short to many because the material was not always presented in a fashion either logical or particularly engaging to clinical professionals. As Mills remarks, “The current criteria are basically a Word document with a table in the middle.”

For this revision, a partnership between ASAM and The Change Companies, where Mee-Lee serves as a senior vice president, is taking advantage of the latter entity’s expertise in engaging customers with products such as its interactive journals that target special populations in treatment.

“One of the largest overriding themes was that this had been a difficult manual to navigate for the practitioner,” says Frankie Lemus, a senior vice president at The Change Companies. “Now there will be tabbing in the criteria, and the content will also match the typical flow of treatment.”

New priorities

A great deal has occurred in the addiction treatment community since the last update of ASAM’s clinical criteria. As Mills points out, the medication buprenorphine had not even hit the scene yet to transform the notion of how opiate addiction treatment could be structured.

The new criteria, which will be out both in book and software program form simultaneously in October, take into account the emphasis on integrated care and the need to address co-occurring mental health and physical health disorders in patients with addictions. Other areas such as gambling and tobacco use have their own chapters in the new manual, while clinical criteria for adolescent treatment will now be woven into the overall criteria as opposed to being relegated to a separate section.

Four special populations also are receiving their own sections in the new criteria. These populations are individuals in safety-sensitive professions; persons in the criminal justice system; older adults; and parents and pregnant women. Mills says these groups were selected for this distinct treatment mainly because their needs often require that clinical protocols for them unfold somewhat differently from those for the general treatment population.

The revised ASAM Criteria also will reflect changes outlined in the field’s newly revised diagnostic manual for behavioral disorders, the DSM-5 (such as the fact that “dependence” and “abuse” categories for substance use are no longer part of the DSM). Yet Mills says there still will be some distinctions in definitions between the ASAM Criteria and the American Psychiatric Association’s (APA’s) publication.

Vetting process

The process of revising the criteria has been several years in the making, featuring separate lead authors for each of the main content sections and extensive field review. The process of course has also been informed by years of feedback that has been received about the most recent revision.

Some of the content experts who have been heavily involved in key sections of the manual include longtime psychologist, trainer and consultant Gerald Shulman; Marc Fishman, MD, who leads Maryland Treatment Centers and has served as president of the Maryland Society of Addiction Medicine; and Michael Miller, MD, medical director of the Herrington Recovery Center at Rogers Memorial Hospital.      

A website has been created for information about the criteria, including pre-ordering details.

Continue to look to Addiction Professional this year for perspectives on changes in clinical standards for the field, including an overall examination of the ASAM Criteria this summer from David Mee-Lee.   

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