ASAM Standards of Care for Addiction Specialist Physicians

Acknowledgments and Endorsements

• The PIPMAG project funded by:
  • Substance Abuse and Mental Health Services Administration (SAMHSA)
  • National Institute on Drug Abuse (NIDA)
  • National Institute on Alcohol Abuse and Alcoholism (NIAAA)
• Recognition of contributors:
  • Steering Committee Chairs: Drs. Michael Miller, Margaret Jarvis, Corey Waller, and David Pating
  • Expert consultant: Mady Chalk, PhD
  • ASAM staff involved: Susan Awad, Beth Haynes, Alexis Geier-Horan, and Penny Mills
• Document endorsed by the American Osteopathic Academy of Addiction Medicine (AOAAM).

Committee and Panels

• PIPMAG Steering Committee includes:
  • Michael M. Miller, MD, FASAM, FAPA (Chair)
  • Melinda Campopiano, MD (SAMHSA)
  • Mady Chalk, PhD (Consultant)
  • Others: Sarah Duffy, David Gastfriend, Daniel Kivlahan, Margaret Kotz, Rebecca Kresowik, Cherry Lowman, Dennis McCarty, Elinore McCance-Katz, Jack McIntyre, Laura McNicholas, Harold Pincus, Cary S. Sennett, Hyong Un, Jeffery N. Wilkins.
• Expert Panels:
  • Standards and Outcomes of Care Expert Panel, Performance Measures Expert Panel, and Field Review Panel.

Introduction

• Background and Purpose of Standards:
  • Address responsibilities of physicians managing addiction care.
  • Intended for quality improvement in health care practices and policies.
  • Applies to all physicians caring for addiction and related disorders.
  • Supports improved patient outcomes through expected competencies.
  • Dynamic document subject to revisions from ASAM based on ongoing feedback.
  • Not setting-specific but generally applicable to various addictions.

Addiction Specialist Physicians and Professionalism Expectations

• Definition:
  • Addiction physicians hold various certifications in addiction medicine and psychiatry.
• Responsibilities include:
  1. Staying updated on laws concerning substances and patient privacy.
  2. Ensuring informed consent and understanding of privacy limits.
  3. Maintaining licensure and engaging in lifelong learning to stay competent.
• Quality care should focus on overall patient well-being and address concurrent issues.

Addiction Specialist Physician Leadership

• Role as a leader in treatment teams addressing complex addiction issues.
• Facilitating integration of addiction treatment into mainstream health services.
• Involvement in assessments, quality assurance, and educational efforts for future practitioners.

Implications and Next Steps

• Moving toward integrated addiction treatment, necessitating negotiation of new care protocols.
• Setting benchmarks for quality of care that reflects physician expectations in treating substance use disorders.
• Planning future performance measures based on the established standards.

Standards Overview

• I. Assessment and Diagnosis: Ongoing evaluation processes during initial treatments.
• II. Withdrawal Management: Critical part of the treatment linked to ongoing substance treatment.
• III. Treatment Planning: Coordinating integrated treatment approaches considering patient environments.
• IV. Treatment Management: Overseeing care quality, whether through direct treatment or management of care.
• V. Care Transitions and Coordination: Facilitating effective transitions and information sharing among caregivers.
• VI. Continuing Care Management: Ongoing monitoring post-stability to promote sustained recovery.

Comprehensive Assessment: Key Components

• Standard I.1: Initial assessment must include:
  • Physical and mental status exams.
  • Medical and psychiatric history.
  • Detailed substance use history and current medication.
  • Analysis of recovery environment and potential barriers.

Withdrawal Management

• Standard II.1: Assessing withdrawal management needs, including intensity and treatment environment.
• Standard II.2: Provides validated medical interventions and monitors withdrawal symptoms.

Treatment Planning

• Standard III.1: Coordinate comprehensive patient care addressing addiction and related issues.
• Standard III.2: Discuss therapeutic alternatives and involve patients in decision-making.

Continuing Care Management

• Standard VI.1: Encourage ongoing recovery management through scheduled assessments for sustained sobriety.