Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

COVID-19-Related Project Enhancement

In response to COVID-19, addiction treatment programs have shifted from in-person care to telehealth. Telehealth provides care to patients remotely using phone, video, or other devices to help manage care. It is unclear how COVID-19 or telehealth affects access to treatment.

With this enhancement, the research team will first look at whether and to what extent COVID-19 limits starting treatment for substance use problems. They will also assess the effect of telehealth on treatment. The team will compare:

  • Starting treatment via telehealth versus in person
  • Where treatment takes place, for example at a center versus telehealth
  • Care received before and after changes to the criteria that reduce in person care during COVID-19

The study includes people who have substance use problems and Medicaid.

Enhancement Award Amount: $291,436
 

What is the research about?

Substance use problems play a part in 135,000 U.S. deaths each year. Addiction treatment that meets patients’ needs can prevent death and disability. Effective treatment can also improve people’s relationships, make it easier to keep a job, and reduce criminal behavior. But few people get the treatment that best matches their needs. About 1 in 10 Americans with a substance use problem get treatment; 1 in 3 patients don’t finish it.

The American Society of Addiction Medicine, or ASAM, created criteria for matching patients to treatment based on their specific needs. Patients answer questions about substance use, physical and mental health, readiness to change behaviors, chance for relapse, and recovery setting. Studies show that using the ASAM criteria helps patients stay in treatment and get better results compared to care without treatment matching.

Some counties in California require clinicians who treat addiction, such as doctors and nurses, to use the ASAM criteria to match patients to treatment. In this study, the research team is looking at how this requirement affects addiction treatment outcomes for patients in California. The team also wants to learn whether using the criteria changes how clinicians and patients talk about treatment options.

Who can this research help?

Policy makers, healthcare administrators, insurers, and clinicians can use findings from the study when considering ways to help patients with substance use problems get the treatment that works best for them. 

What is the research team doing?

The study focuses on adults who have Medicaid coverage and who get treatment for addiction in California. The research team is asking about 700 patients to answer questions about their treatment, such as whether

  • They received information about different treatment options
  • They understood the purpose of having an assessment of their treatment needs
  • The assessment focused on their needs

To track treatment results, the research team is using data that the state collects.  

The study is comparing results between counties that do and don’t use the ASAM criteria. The research team is tracking patients for one year, looking at how many patients follow treatment for at least 14 days. They are also tracking whether patients use alcohol or drugs and where treatment takes place. The team is also asking patients about their discussions with healthcare providers about treatment options.

The research team is working with a group of patients who have addictions and who are in recovery, healthcare providers, and county and state behavioral health departments to plan and conduct the study.

Research methods at a glance

Design Elements Description
Design Observational: case-control study
Population Medicaid beneficiaries ages 19 and older in specialty addiction treatment programs in California 
Interventions/
Comparators
  • Counties using ASAM protocols as part of comprehensive biopsychosocial assessments
  • Counties not using ASAM protocols
Outcomes

Primary: retention in treatment, substance use reduction

Secondary: treatment setting, communication between providers and patients about treatment options

Timeframe 1-year follow-up for primary outcomes

Journal Articles

Project Information

Tami Mark, PhD, MBA
RTI International
$2,228,180

Key Dates

36 months
November 2017
March 2022
2017

Study Registration Information

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Last updated: September 27, 2021