Guidelines for patient treatment matching In the substance abuse treatment system: Feasibility, predictive validity and improvement

Substance use disorders (SUD) are highly prevalent, the patient population with these disorders is heterogeneous and there is a diversity of evidence based treatments available. Important element in a treatment of patients with a SUD is patient-treatment matching which is to select from amongst all available alternatives that treatment or these treatments that are most likely to facilitate a positive outcome in a particular individual.
First goal of our research project was to test the feasibility of implementing guidelines for matching patients with SUD to different treatment intensities (levels of care; LOC) in two Dutch substance abuse treatment centres, based on the stepped care paradigm. Second goal was to test the predictive validity of a priori treatment allocation guidelines in terms of treatment outcome. Both studies used a observational follow-up design.
With respect to our first goal, the feasibility of allocating patients with SUD to appropriate LOCs using guidelines for assessment and placement was seriously limited due to inadequate data collection of patient characteristics and suboptimal guideline-based treatment allocation.
With respect to our second goal, using our a priori treatment allocation guidelines was not associated with better outcome. Patient treated at a more intensive LOC than recommended had better treatment results compared to patients who were treated at the recommended LOC.
We concluded is that our current guideline for patient-treatment allocation, based on the stepped care approach, is no longer tenable. The algorithm that is currently used contains several important design flaws. Unfortunately, there are no evidence based alternatives that could be used in routine practice for allocating patients to LOCs. Redesigning the existing allocation guidelines seems more appropriate.