Trends and Associations in Patient Ratings Using the American Society of Addiction Medicine Criteria, 2013-2022

Matching individuals to the appropriate substance use treatment level is related to treatment and other health outcomes. However, only 1 study has explored whether ASAM Criteria for placement ratings differ based on demographic or contextual factors. This study aims to determine if factors commonly related to treatment outcomes correlate with ASAM placement ratings.

This repeated cross-sectional study examined 1955 assessments of individuals served by Kentucky's Sobriety Treatment and Recovery Teams (START) program from 2013 to 2022. START serves parents referred to child welfare services because of substance use. Ordinal logistic regression was used to analyze the relationship between demographic factors and ASAM level of care recommendations.

Over the study period, recommendations for intensive outpatient decreased, while recommendations for outpatient and inpatient/residential increased. The ordinal logistic regression model identifying correlates of ASAM level of care ratings found that age and being a woman were positively associated with the odds of being assessed as needing a higher level of care, whereas compared with White people, Black people and people of other races had lower odds of being recommended higher levels of care. The year of assessment and the county were also associated with ASAM recommendations.

Future studies should explore whether differences in ASAM ratings among racial groups are consistent across samples. If so, it will be critical for the field to understand whether these differences are driven predominantly by variations in substance use severity among racial groups or whether they represent underassessment among members of minoritized groups.