Factors associated with level of care assignment in substance abuse treatment

Managed-care approaches to controlling expenditures for publicly funded substance abuse treatment have proliferated in the past decade. As many as 40 states now have some type of utilization review mechanism. Many have adopted the American Society on Addiction Medicine placement criteria to assign persons to a level of care. This study examined the use of those criteria with 3,000 consecutive admissions to publicly funded treatment in Kansas and identified variables that predicted level of care assignment. For the most part, the placement domains predicted level of care as expected. However, even when controlling for the contribution of the placement domains, housing status and employment were among the best predictors of placement. These findings suggest a need for criteria that address social service as well as clinical concerns when working with vulnerable populations.