(58) ASAM Levels of Care in a Specialty OB/GYN Clinic

Introduction: The ASAM Criteria is a widely validated tool for determining levels of care (LOC) among patients with substance use disorders (SUD) (1). However, a scarcity of research has investigated the utility of these criteria for pregnant and recently postpartum (i.e., perinatal) women. SUDs in this high-risk population are associated with acute maternal or fetal withdrawal during delivery, as well as developmental and psychosocial problems for infants later in life (2). Several specialized clinics for dual obstetric and addiction treatment have been established to meet the needs specific to this population, however it is unclear if and how these clinics utilize the ASAM Criteria in treatment planning. The current study reviews the potential utility of ASAM Criteria in assessing congruence between current and ideal patient LOC in relation to SUD outcomes at a specialized perinatal clinic.

Methods: A trained chemical dependence counselor conducted a review of 32 patient records consisting of 266 office visits taking place between October 2020 and June 2021. Patients eligible for care at the specialized clinic have a primary SUD diagnosis during pregnancy. Each visit received a score based on clinical notes for all 6 dimensions of the ASAM Risk Rating Crosswalk (3) (acute intoxication/withdrawal, biomedical complications, behavioral/emotional complications, readiness to change, potential for relapse, and living environment), which is based on the ASAM Criteria. We assigned each patient visit to an ideal LOC based on scores (outpatient, intensive outpatient, partial hospitalization, or residential treatment). Finally, we noted if aggregate dimensional scores improved over the course of treatment for each patient and used a two-tailed unpaired t-test to compare improvement to the number of visits in which the patient was in the appropriate ASAM LOC.

Results: Of the 266 visits reviewed, in 148 of them (55.6%) the patients were determined to be in the appropriate LOC based on their ASAM dimensional scores. Of the 32 pregnancies reviewed, 17 (53.1%) of the patients showed improvement in their aggregate dimensional scores, while 14 stayed the same or showed little to no improvement. Analysis revealed a significant difference in aggregate score improvement for patients who were noted to be in the appropriate ASAM LOC at their office visits (p < 0.0001).

Conclusions: We were able to successfully use the ASAM Criteria to retrospectively assess LOC. Patients who were more frequently in the appropriate LOC showed improvement in their SUD treatment as measured by the ASAM Criteria. These results reveal: (1) treatment at this specialty OB/GYN clinic portends favorable outcomes among perinatal SUD patients and (2) the ASAM Criteria could be a beneficial tool in promoting these outcomes at such a clinic. We hypothesize that using the ASAM Criteria during the initial patient intake could lead to better patient outcomes. For instance, past research has noted that implementing ASAM Criteria was associated with a more patient-centered intake and higher satisfaction with their treatment choice (4). Future directions should further assess the feasibility of incorporating ASAM Criteria into dual obstetric and addiction clinics.

References: 1. Kampman K, Jarvis M. American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. J Addict Med. 2015;9(5):358-367. doi:10.1097/ADM.0000000000000166
2. Frazer Z, McConnell K, Jansson LM. Treatment for substance use disorders in pregnant women: Motivators and barriers. Drug Alcohol Depend. 2019;205:107652. doi:10.1016/j.drugalcdep.2019.107652
3. Mee-Lee D, Shulman GD, Fishman MJ. The ASAM criteria: treatment criteria for addictive, substance-related, and co-occurring conditions. 3rd Ed.Carson City, NV:The Change Companies; 2013.
4. Mark TL, Hinde J, Henretty K, Padwa H, Treiman K. How Patient Centered Are Addiction Treatment Intake Processes?. J Addict Med. 2021;15(2):134-142. doi:10.1097/ADM.0000000000000714