The ASAM criteria was established to define the criteria that should be used in the process of patient placement and determines the level and intensity of care that one should receive. There are six dimensions under the ASAM criteria which are used to, for instance, explore an individual’s history of health and his or her currently physical condition (Dimension 2). In the assigned case, Kendra is a 55-year old single white American female. The recommendation for treatment given under each dimension of the ASAM criteria is not appropriate for such a client based on various reasons. For instance, under dimension 1, Kendra is said to have 3-5 drinks 1-3 times a week. The assessment states that she is drinking less and is therefore not at risk of withdrawal leading to her being recommended for outpatient treatment. However, such a recommendation overlooks the fact that Kendra started drinking when she was a teenager and has never stopped. Due to her drinking behavior, she has experienced numerous problems in most areas of her life especially when it comes to family relationships. Kendra admits that she is an alcoholic. Recommendations given under each dimension refer that Kendra should receive outpatient care which is the main point of concern. A closer review of her background information demonstrates that she needs a more extensive treatment plan one that involves her being admitted to a rehabilitation center.
The evaluation should focus on Kendra’s ability to form healthy social relationships with family and friends. She has had numerous issues with forming strong bonds with individuals close to her. Such information could help determine whether choosing outpatient treatment is a feasible approach that can help her experience a change in behavior. One could find out whether she is contact with any family members and what they perceive of her. Being that she considers herself an alcoholic, it would be better to identify whether this particular state of being exposes her to stigma and discrimination form the people she interacts with. Having such information could help determine whether Kendra should be admitted or if she has individuals who can help her adopt a new healthier behavior to improve her mental, physical, and social health.
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The ASAM criteria defines addiction as being a “… primary, chronic disease of the brain reward, motivation, memory and related circuitry” implying that dysfunctions in these circuits lead to characteristic biological, psychological, social and spiritual manifestations. Based on this definition, addiction is presented as being a state that can be overcome through focusing on, for instance, how environment stimuli motivate a particular unwanted behavior in an individual. For a person like Kendra, having access to alcohol motivates her to drink. The criteria is effective and sensitive as it emphasizes the need for individuals to not stigmatize others through labeling such as how Kendra calls herself an alcoholic. A more sensitive approach would be to say that Kendra suffers from alcoholism and that she is not an alcoholic, which is a term depicting permanency. The criteria can help guide one to focus on specific areas of a client’s experiences that probably have promoted existence of certain mental health and behavioral issues.
Stallvik, Gastfriend and Nordah (2014) conducted a study focusing on matching patients with substance use disorder to optimal level of care with the ASAM criteria software. The authors found that retention differed across respondents. For instance, in matching/over-matching, the level of retention was 62% compared to 45% of those under-matched. When it comes to patients ready to step-down to a lower level of care, 61% belonged to the matched group, while 46% and 17% represented those in under-matched and over-matched groups (Stallvik, Gastfriend & Nordah, 2014). The results demonstrate the effectiveness of the ASAM criteria in placing patients with the level of care they need. One can notice that those matched appropriately experienced a high level of retention and were ready to step-down to a lower level of care.
Reference
Stallvik, M., Gastfriend, D. R., & Nordahl, H. M. (2014). Matching patients with substance use disorder to optimal level of care with the ASAM Criteria software. Journal of Substance Use,20 (6), 389-398. doi:10.3109/14659891.2014.934305
