1. The University of Georgia 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)

2. The University of Georgia 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?

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

4. The University of Georgia 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

5. The University of Georgia Previous Research (Survival)

6. The University of Georgia 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

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

8. The University of Georgia 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

9. The University of Georgia 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

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

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

12. The University of Georgia Computerized Scoring Software

13. The University of Georgia 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

14. The University of Georgia 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

15. The University of Georgia 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