1. Retrospective evaluation of ASAM criteria in adolescents receiving weekly outpatient treatment for co-occurring psychiatric and substance use disorders Beverly Holmes 1, Louise Haynes 2, Jeff Leimberger 3, P.aula Riggs 4 1 Lexington-Richland Alcohol and Drug Abuse Council, 2 Medical University of South Carolina, 3 Duke Clinical Research Institute, 4 University of Colorado, Denver American Society of Addiction Medicine (ASAM) criteria are widely used to determine level of care/treatment intensity. However, there is a lack of research on the validity of ASAM placement criteria in adolescents with co-occurring psychiatric and substance use disorders (SUD), who generally meet ASAM criteria for more intensive treatment. We could find no studies evaluating whether integrated treatment approaches for co-occurring disorders might produce similar outcomes to more intensive (and costly) level of care. We present preliminary data addressing this research gap. 18% (n=6/32) met ASAM Level 1 criteria (outpatient); 40.5% (n=13/32) met ASAM Level 2 criteria (intensive outpatient); and 40.5% (n=13/32) met ASAM Level 3 criteria (residential) (Figure 1). R etrospective chart reviews were conducted to determine ASAM placement criteria in 32 adolescents who participated in a randomized controlled trial Osmotic-Release Methylphenidate (OROS-MPH) for attention deficit hyperactivity disorder (ADHD) and substance use disorders (NIDA CTN 0028). As shown in Figure 2, below, 100% of participants meeting ASAM Level 1 completed 16 weeks of treatment and were 80.3% compliant with CBT session attendance. Of participants meeting ASAM Level 2, 76.9% completed 16 weeks of treatment and were 70.7% CBT attendance compliant. Of participants meeting ASAM Level 3, 76.9% completed 16 weeks of treatment and were 72.5% CBT attendance compliant. There were no statistically significant differences between groups in treatment completion or CBT session attendance. Treatment compliance and completion were higher than expected given the severity of substance abuse and psychopathology in this sample. Treatment outcomes were comparable across all three groups despite the fact that 82% of the sample would have been assigned to more intensive treatment based on retrospective determination of ASAM placement criteria If replicated, results suggest that less intensive integrated treatment approaches may produce comparable outcomes to more intensive (and more costly) treatment approaches (e.g. IOP, residential) for adolescents with co-occurring psychiatric and substance use disorders. More research is needed on the validity of ASAM placement criteria in adolescents with co-occurring psychiatric and substance use disorders. Supported by NIDA U10DA13727 Figure 1: ASAM placement criteria based on retrospective chart review Figure 2. Treatment Completion and Compliance with CBT Session Attendance Similarly there was not a statistically significant difference in reduction in days of past 28-day drug use between ASAM Levels 1 (-1.0 day), 2 (-3.7 days), or 3 (-0.7 days). Figure 3. Baseline demographics and clinical characteristics Background Methods Methods (Continued) Results Results (Continued) Conclusion Acknowledgements All participants received individual weekly outpatient cognitive behavioral therapy (CBT) for substance abuse throughout the 16 week medication trial. All participants met DSM-IV diagnostic criteria for ADHD and at least one non-tobacco SUD. Participants meeting criteria for ASAM Level 1 (outpatient treatment), ASAM Level 2 (intensive outpatient) and ASAM Level 3 (residential treatment) were compared on treatment outcome measures including: 1. treatment completion; 2. treatment compliance (CBT session attendance); and 3. substance use.