Clinical-based vs insurance-based recommendations for substance abuse treatment level
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Updated: Nov 4, 2026

Investigating Drivers of Antireward in Addiction Behavior with Anatomically Specific Single-Cell Gene Expression Methods
Published on: August 4, 2022
E Gondolf1, K Coleman, S Roman
1Mid-Atlantic Addiction Training Institute, Indiana University of Pennsylvania 15705, USA.
Abstract:
An exploratory study of 250 patients was conducted at three treatment facilities in Western Pennsylvania, USA, to determine: 1) the extent of disagreement between clinical-based [using American Society of Addiction Medicine (ASAM) criteria] and insurance-based [using Managed Care Organization (MCO) criteria] recommendations for treatment levels, and 2) the extend of ASAM recommendations that become the actual treatment. Cross-tabulations showed: 1) ASAM and MCO recommendations were the same for 85% of the cases, and 2) ASAM recommendations became the actual treatment in 93% of the cases. The exceptionally high level of ASAM-MCO agreement suggests a convergence in ASAM and MCO criteria and a deference to ASAM criteria in practice.
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