Treatment Allocation Guidelines on Treatment Outcome in Routine Outpatient Addiction Treatment Using Structured Assessment of Patient Characteristics

Aim: To present the Measurements in Addictions for Triage and Evaluation (MATE): An Instrument Based on the WHO Family of International Classifications and the feasibility of treatment allocation based on it. The predictive validity of a priori treatment allocation guidelines on treatment outcome for outpatients with substance abuse or gambling problems in routine clinical practice will be presented. Hypotheses were: patients matched at the recommended level of care (LOC) have (1) better outcomes than patients treated at a less intensive LOC, and (2) equal outcomes compared to patients treated at a more intensive LOC. Design: Multi-centre observational prospective study comparing treatment outcomes between patients treated at the recommended LOC and patients not treated according to allocation guidelines. Setting: Two Dutch Substance Abuse Treatment Centers. Participants: 472 patients who completed intake, started brief or standard outpatient treatment, and were successfully followed up (44%). Measures: Addiction severity, psychiatric impairment, and level of social stability at baseline necessary to allocate patients to LOC according to the guidelines. Outcome was measured in terms of self-reported substance use or gambling behaviour 30 days prior to assessment. Findings: 30% of the patients was matched to LOC according to the guidelines. The percentage non response was comparable in all three conditions. Patients allocated to the recommended LOC did not show better outcomes than patients treated at a less intensive LOC, and had equal outcomes compared to patients treated at a more intensive LOC. Conclusion: The a priori allocation guidelines were followed in a minority of the patients and did not increase the overall effectiveness of treatment. The predictive validity of the guidelines is partially confirmed. Further discussions are needed regarding the content of the treatment allocation guidelines. treatment, adherence, and 3/6 months clinical outcome.