Use the Capella library to complete the following:
Review a specific addiction listed in the DSM-5 and address what the relevant differential diagnosis would need to rule out. Note what assessments are needed to rule out other mental health or medical disorders (with similar concerns or symptoms) that might be present. What assessments would help support determining the level of severity?
In DSM-5 Made Easy: The Clinician’s Guide to Diagnosis:
Read the Introduction, pages 1–15.
Read Lopez et al.’s 2006 article, “Beyond the DSM-IV: Assumptions, Alternatives, and Alterations,” from Journal of Counseling and Development, volume 84, issue 3, pages 259–267.
Use the Internet to complete the following:
Read Appendix H: Sample Screening Instruments, pages 497–512, in SAMHSA’s Substance Abuse Treatment for Persons With Co-occurring Disorders.
Multimedia
Click the links provided below to view the following multimedia pieces:
The ASAM Criteria – Press Conference – State of the Art Course in Addiction Medicine 2013 [Video] | Transcript
This video describes the history of the ASAM criteria, their importance to the field, and how the new edition can improve care. The video also provides context for the concept of coordinated, or integrated, care.
History of the DSM | Transcript.
This presentation provides further background on the Diagnostic and Statistical Manual of Mental Disorders.
THE ASAM CRITERIA – PRESS CONFERENCE – STATE OF THE ART COURSE IN ADDICTDN OF TREATMENT ANY MORE THAN THERE IS FOR DIABETES. THIS IS A DISEASE WHERE SOMETIMES YOU NEED MORE ACUTE CARE. SOMETIMES YOU NEED TO BE IN REHAB OR HOSPITALIZATION OR WITHDRAWAL MANAGEMENT, BUT THAT WHEN YOU COME OUT YOU ARE NOT ALL BETTER. THAT IS THE POINT WHERE THE ONGOING CARE FOR ADDICTION REALLY TAKES HOLD AND GOES ON INDEFINITELY BECAUSE THE DISEASE IS CHRONIC AND LIFELONG. THAT IS SOMETHING THAT IS NOT GENERALLY RECOGNIZED. DAV
THE ASAM CRITERIA – PRESS CONFERENCE – STATE OF THE ART COURSE IN ADDICTION MEDICINE 2013
Dr. Stuart Gitlow
Good morning and thank you for coming today to learn how the ASAM criteria can revolutionize addiction care. I am Stuart Gitlow. I am President of the American Society of Addiction Medicine. ASAM is a membership organization of more than 3000 physicians and associated health professionals dedicated to increasing access to and improving the quality of addiction treatment. Today we come one step closer to achieving that mission with the release of our new ASAM criteria and the announcement that we will explore the possibility of creating a quality review for addiction treatment programs with the treatment research institute. Since 1954 ASAM has worked tirelessly to raise the quality of addiction care. When we released or first edition of ASAM criteria in 1991 we unified the addiction field with a tool that gave a common language to addiction treatment and provided guidelines for individualized care. At that time there were over 40 criteria in circulation. The National Association of Addiction Treatment Providers known as NAATP asked ASAM to convene stakeholders to create one set of treatment criteria that would be useful to physicians and other healthcare professionals as well as care managers and payers.
That spirit of collaboration lives on today and is why the ASAM criteria has become the most widely adopted treatment criteria for addiction with it being required in some form in over 30 states. Our new edition emerged thanks to broad participation from representatives from groups like NAATP, the National Association of State Alcohol and Drug Abuse Directors, the National Association of Addiction and Drug Abuse Counselors, the National Council on Alcoholism and Drug Dependence as well as managed behavioral groups like Magellan and OptumHealth and government agencies like the Department of Defense and Veteran Affairs. With our 2013 edition we forged forward to promote widespread implementation of the best quality of care. We are releasing a whole package of resources to help clinicians and managed care work together to provide what the ASAM criteria described, that being holistic, appropriate and quality oriented treatment for the chronic disease of addiction. You will hear today from three leaders in the field who have dedicated to their lives to ASAM’s mission of improving the quality of addiction care. Chief Editor of the ASAM Criteria Text, Dr. David Mee-Lee, Chief Architect of the ASAM Criteria Software, Dr. David Gastfriend and Treatment Research Institute’s CEO and Co-Founder Dr. Thomas McLellan. I am pleased to introduce first Dr. David Mee-Lee to speak about how our third edition of the ASAM criteria modernizes standards for treatment of addiction and co-morbidities in line with major advancements in the understanding of the disease of addiction over the past decade. Thank you for coming with us tonight David.
Dr. David Mee-Lee
Thanks very much Stu. You know the general public and even some treatment providers still see addiction treatment as sending somebody off to rehab to a fixed length of stay program to which somebody will complete and graduate. And in line with ASAM’s definition of addiction this new edition, and this is it, really has reaffirmed and expanded what we have done since the beginning of the first edition in 1991 and that is to introduce and develop a wide range of services and levels of care to encourage and give people the best chance to end their treatment and recovery and to maintain to recovery and wellness. You know if care providers, care managers, people who pay treatment, pay for treatment really embrace the principles of the ASAM criteria we would actually see how a difference, we would do an engaging and attracting people into recovery. We would see a difference about how we design, deliver and pay for levels of care and the continuum of care. We would see a way, how we would differently assess people’s needs, strengths, skills and resource and collaborate with them in terms of an individualized treatment plan. And we would actually see a difference in how we provide the services for ongoing disease management to get good outcomes.
So the ASAM criteria are not just admission criteria about getting somebody into a level of care. There really especially with this new edition looking at how do we develop a system of care that would really address and reach out to the more than 23,000,000 people 12 years and up who need addiction treatment of whom about only 2.5 million actually enter specialty addiction treatment. So this new edition really has an emphasis on moving way beyond placement criteria to looking at guiding the broader field in attracting and engaging all of those people that need addiction treatment. So if we embrace the spirit and the content of the ASAM criteria it will together help us to increase access to care by decreasing waiting lists, by being good stewards of resources to stretch limited resources as far as possible to give people all the care they need; not more intensive care than the need, because that is wasteful of resources, not less intensive care than people need; that is also wasteful of resources and certainly bad for people. And if we really embrace the spirit of the ASAM criteria it will help us to develop and use the continuum of care of services to give people the best chance for ongoing healthy recovery and wellness. So we encourage you to look at the ASAM criteria to help guide us in this new era of reaching too many people who cannot yet still access services. Thank you.
Dr. David Gastfriend
Good morning. I am David Gastfriend. I am an addiction psychiatrist and a researcher who began computerizing the ASAM criteria in 1993 in my Massachusetts General Hospital lab at Harvard Medical School. We knew then that the ASAM criteria book makes sense both clinically and scientifically. But we also knew that no one could memorize it, not even the authors; so we wing it. Programs, reduce it to a one page little form. States eliminate entire levels of care. Managed care says providers interpret the ASAM criteria. All of this takes the name of the ASAM criteria in vain and it is time it is stopped. After 20 years of research we now know that the ASAM criteria can be properly applied if we use the computer. If we used the guided interview, research quality questions, intelligent branching, in the interview we ask questions, type the answers, the computer can output a three to five page detailed report with the DSM substance use disorder diagnoses, the patient’s severity, the eminent risks and recommended levels of care. The software has good face validity, good inter-rater reliability, good predictive ability and when counselors use it, patients drop out less. They have better 90-day outcomes. They have lower addiction severity. They have fewer 12-month re-hospitalizations. This happens with expert counselors and with novice counselors, but what is more counselors like it, patients like it. They say, best intake I have ever had. I realized just how sick I really was and I see why this treatment is more right. These findings come from around the United States and from all over the world, from Massachusetts, New York, the VA, Belgium, Norway, even if you can believe it, Uzbekistan. Language is no longer a barrier to good standardized assessment.
And finally we no longer need today’s aggravating telephone dual with managed care. It is not the ASAM criteria software is the antidote to managed care, it is managed care. It just happens to be good managed care. The research has been funded with over $7,000,000 from NIDA, NIAAA, CSAT and the governments of Belgium and Norway. The planning has been done thanks to a year-long study by the Harvard Business School. The new software program was sponsored by SAMHSA, which as now together with ASAM endorsed the ASAM criteria software as the official implementation of the ASAM criteria. Following successes without the testing in Norway and Beta testing in Milwaukee County today we announce the inauguration of the National Pilot Project for the ASAM criteria software. Who should sign up? Programs that are willing to have some of their tech savvy counselors try it out for a few months. There is no risk. There are no tech requirements other than having a current internet browser and laptop or desktop computer. It requires minimal training. Costs will be very low by agreement with SAMHSA and ASAM. Security is very high to federal government specifications. It meets international health by two standards for electronic health records. Privacy and confidentiality are very strong, meeting both HIPAA and 42 CFR requirements. By signing up for the National Pilot Project programs will get to see how it works, how well it works and how it helps. Programs that sign up will become the new national leaders in clinical care. ASAM will then take the feedback from these national program leaders and improve the software in time for a full commercial national launch. The project arrives just in time for the convergence of healthcare reform, parody legislation, the health information technology revolution and meaningful use standards. ASAM is thrilled after 20 years to finally bring the ASAM criteria software to reality. Thank you.
Dr. Thomas McLellan
Hi I am Tom McLellan. I am the CEO of the Treatment Research Institute. And as Stuart said I am an expert in addiction. I have published some papers. I have consulted, et cetera. But when my own kid needed addiction treatment it was like the funeral industry. Extraordinary claims, very emotional time, I did not know where to send my own kid. That is no longer the case thanks to ASAM and the work that has been sponsored by the National Institute on Drug Abuse to develop ways of measuring quality and measures of the extent to which a program meets the ASAM criteria. This has been an extensive test in partnership with ASAM, with consumer reports and with TRI. We have used exactly the same measurement model that “Consumer Reports” uses when they measure and compare the quality of refrigerators, insurance programs or college educations. You can, you can measure and quantify the nature and amount of effective services that a program offers. In this way a consumer has some basis for making an informed decision for where to send their child. Similarly this is the kind of effort that will bring and maintain integrity to the ASAM criteria that David and David have previously talked to you about. We are very proud to be working with ASAM. We think it is going to be a service to consumers and a service to payers. Thank you.
Dr. Stuart Gitlow
Thank you all very much for joining us today. We would be happy to take any questions should there be any from the audience.
Speaker
Does the field currently treat addiction as a chronic disease and if so how do they set criteria to help make that possible?
Dr. Stuart Gitlow
Gentlemen?
Dr. David Gastfriend
There are two sets of people that get addiction treatment as a chronic illness. It is the height of unfairness as a matter of fact. If you want the right kind of and the right quality of addiction treatment you have to be an addicted physician or an addicted airline pilot. They get five years of care and it works. It works beautifully. Any measure you want they do very, very well. They get the same initial care that anybody else gets but that is followed by management support, monitoring for them and their families. This is the kind of thing that could be brought to the rest of the American public. I mean imagine a situation where I said there is really effective diabetes treatment but I am sorry you have to be a doctor in order to get it. The American public would not put up with that. There is effective addiction treatment and we should be able to have it for everybody.
Dr. Stuart Gitlow
One of the difficulties we have had has been that if you look at a recent example there was a TV star who died of a heroin overdose. And I was asked afterward did he not have treatment? Did he not go to rehab? But we have all known that he had gone to rehab and, in fact, had gone twice and the expectation was that he completed treatment. And I was asked that by the press several times. Well he completed treatment. He should have been fine. And I said, “There is no completion of treatment any more than there is for diabetes. This is a disease where sometimes you need more acute care. Sometimes you need to be in rehab or hospitalization or withdrawal management, but that when you come out you are not all better. That is the point where the ongoing care for addiction really takes hold and goes on indefinitely because the disease is chronic and lifelong. That is something that is not generally recognized. David.
Dr. David Mee-Lee
Since the first edition of the ASAM criteria of 1991 in each level of care we have had the statement about the length of stay in that level of care. And since 1991 we have had no numbers in that. It has always been the time that a person stays in treatment in that level depends on their severity of illness and their progress in treatment. Unfortunately though, our field has still struggled with treating this as a chronic disease. And that really has been the mission of the ASAM criteria since its beginning because as Stu mentioned people still think of people going to rehab and completing treatment. So we got a long way to go even though we have talked about this message for a long time. We need to help providers and payers understand this is a chronic disease and to bring into alignment all of our services and the way we design and deliver services to match that. And with this new edition I think we have the opportunity to expand that message and to reach out, especially in terms of healthcare reform to where the customers really are, which is not in specialty addiction treatment programs.
Dr. Stuart Gitlow
Thank you all for joining us this morning. We appreciate you joining with us and coming to the press conference and we will end here. Thank you again.
[ Applause ]
VIDEO SOURCE
YouTube
CREDITS
Subject Matter Expert:
Charles Walker
Interactive Design:
Kate Bendzick
Instructional Design:
Melissa Williams
Project Management:
Courtney Judd
Licensed under a Creative Commons Attribution 3.0 License.
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