Software Helps Improve Treatment Selection

The ASAM Criteria Software, based on the ASAM Patient Placement Criteria-2nd Edition Revised (PPC-2R), assists addiction counselors in assessing patients in a consistent and comprehensive manner, producing a level of care recommended by the PPC that until now only existed on paper, says David Gastfriend, M.D., a Newton, Mass., addiction psychiatrist who led the software’s development.

After 15 years of research and more than $7 million in federal and international funding, the system is now ready for evaluation by commercial health information technology companies in U.S. treatment programs, he says. After the Harvard Business School conducted a yearlong study that determined the software was commercially viable and defined a strategy for adoption, ASAM now has a business plan to guide creation of system licenses.

The first software firm to implement the system is Sigmund Software, LLC, Brewster, N. Y., (booth No. 93) and the first U.S. treatment program to commit to evaluating the ASAM Criteria Software is Addiction Recovery Resources Inc., New Orleans. Dr. Gastfriend is discussing the ASAM Criteria Software with other programs, including the Caron Foundation, a multi-state treatment system based in Wernerville, Pa.

He has also been negotiating with the federal Substance Abuse and Mental Health Services Administration (SAMSHA) for six months, “to incorporate the ASAM Criteria Software into the SAMHSA Open Behavioral Health Information Technology Architecture (OBHITA). This has far-reaching implications, and we are excited about its prospects,” Dr. Gastfriend says. “ASAM is being asked to provide the question items and screen sequence for single-patient evaluations, which would be offered nationally, free-of-charge, to end-user systems,” including states and treatment programs.

This is the only ASAM-endorsed software for patient placement, he says. Whether the decision is to prescribe outpatient counseling, detoxification, rehabilitation, or other interventions, each course of action requires a different level of services, intensity or restrictiveness, he says. The PPC-2R involves 380 textbook pages, “full of intricate rules,” that comprehensively consider how to manage, for example, a patient with high blood pressure worsened by withdrawal, plus depression, plus poor motivation, in an abusive marriage, Dr. Gastfriend says.

The software presents a computer-guided interview to help the counselor assess the patient, with a computer algorithm covering 150 pages of Excel spreadsheets—in eight-point font. In a clinically logical order, the software assists the interviewer to ask a particular sequence of questions that are individualized for the patient and can probe more deeply as needed based on the patient’s answers, he says.

Following three years of testing in Norway, with funding by the Norwegian government, the PPC-2R software will next be tested in the U.S. by Addiction Recovery Resources Inc., says A. Kenison Roy III, M.D., FASAM, the facility’s founder and Medical Director.

That program will be a beta-testing site, providing a trial of the ASAM Criteria Software before it goes into commercial use.

The testing will help establish the value of the software in helping the provider tailor the selected treatment to the condition of the particular patient, Dr. Roy says, with all concerned being comfortable with that selection and not selecting a treatment “just because that treatment needs patients.”

ASAM is on the cutting edge in developing measurable criteria for services and levels of structure for treatment of addiction—the first to develop these kinds of guidelines for mental health or brain-related health conditions, he says. This will provide criteria for the appropriate level of treatment, especially for the benefit of communication with insurance companies.

The ASAM PPC-2R software will define the various parts of the spectrum of services for addiction, the types of treatment, whether ambulatory or residential, for example. This will help select the type of treatments that are needed and define the types of treatment that are available, Dr. Roy says.