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Quick Guide
For Clinicians

Based on TIP 13
The Role and Current
Status of Patient
Placement Criteria in the
Treatment of
Substance Use
Disorders

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Contents
Why a Quick Guide?  . . . . . . . . . . . . . . . . . . . 2
What is a TIP?  . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction  . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Role of Patient Placement Criteria in a
Managed Care Environment  . . . . . . . . . . . . 7
Building Support of Adopting UPPC  . . . . . . 13
Ethical and Legal Issues  . . . . . . . . . . . . . . 17
Glossary of Terms  . . . . . . . . . . . . . . . . . . . 19

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Quick Guide
For Clinicians

This Quick Guide is based almost entirely on information con
tained in TIP 13, published in 1995, and based on information
updated through approximately 1993.  No additional research
has been conducted to update this topic since publication of
the original TIP.
Based on TIP 13
The Role and Current
Status of Patient
Placement Criteria in the
Treatment of Substance
Use Disorders

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2
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

WHY A QUICK GUIDE?

This Quick Guide was developed to accompany
The Role and Current Status of Patient Placement
Criteria In the Treatment of Substance Use
Disorders, Number 13 in the Treatment
Improvement Protocol (TIP) Series published by
the Center for Substance Abuse Treatment (CSAT),
Substance Abuse and Mental Health Services
Administration. This Quick Guide is based entirely
on TIP 13 and is designed to meet the needs of
the busy clinician for concise, easily accessed
"how-to" information.

The Guide is divided into five sections (see
Contents) to help readers quickly locate relevant
material.

Terms related to placement criteria are listed on
page 19 in the Glossary of Terms. Some of them
are used in this Quick Guide; others are included
to enable clinicians to talk knowledgeably with
their clients and clients' medical providers.

For more information on the topics in this Quick
Guide, readers are referred to TIP 13.

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What Is a TIP? 3

WHAT IS A TIP?

The TIP series has been in production since 1991.
This series provides the substance abuse treat
ment and related fields with consensus-based,
field-reviewed guidelines on topics of substance
abuse treatment.

TIP 13, The Role and Current Status of Patient
Placement Criteria In the Treatment of Substance
Use Disorders

 Addresses the concerns of a broad range of
readers including clinicians, counselors, social
workers, medical personnel, mental health
workers, program administrators, and policy-
makers
 Lists numerous resources for further informa
tion
 Provides a reference on the status of patient
placement criteria in the treatment of sub
stance abuse disorders
See the inside back cover for information on how
to order TIPs and other related products.

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4
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

INTRODUCTION

One of the goals of substance abuse treatment is
to establish uniform patient placement criteria
(UPPC) to accurately assess the severity of a
client's problems in three areas: medical, psycho
logical, and social. However, neither this Quick
Guide nor TIP 13 set these criteria. Their purpose
is to lay the ground work for developing the crite
ria. These products vocalize the concerns of peo
ple who have a stake in the creation of a UPPC
and provide information on the sets of criteria and
issues in development.

Recommended Characteristics of Uniform
Criteria

UPPCs play an important role in matching place
ment to cost-conscious, effective treatment. Both
payers and providers may accept patient place
ment criteria, assuming those criteria

 Accurately describe their levels of care
 Have validity regarding recommended place
ment level
 Are easy to use in real-time clinical decision-
making 
 Include reliable and objective tools and lan
guage

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Introduction 5

 Encourage positive treatment outcomes in the
least restrictive environment
Without uniformity, there are no common defini
tions of care, no common language, and no
capacity to effectively perform and compare the
essential research.

Advantages of UPPC

 A common vocabulary can allow clinicians to
more easily consult about clients or programs.
 Uniform criteria can provide a common basis for
study and continued improvement of both the
criteria itself and services provided as a result.
 UPPC can help alleviate the high cost of under-
treatment by ensuring patients get all the treat
ment they need.
 UPPC can alleviate the cost of overtreatment by
ensuring patients get only the treatment they
need based on assessment and uniform criteria.
 Common definitions of levels of care, common
standards of assessment, and common stan
dards for continued stay and discharge can
establish the same framework for public and
private programs.

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6
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

Bringing consistency to placement decisions has a
number of advantages, but the development of the
criteria presents challenges. In some situations,
the advantages are not recognized. In other situa
tions, the task of implementation is daunting
because of limited resources, geography, multiple
funding systems, or separate treatment systems
for public and private clients.

For more detailed information, see TIP 13, 
pp. 14.

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The Role of PPC in a Managed Care  Environment 7

THE ROLE OF PPC IN A MANAGED
CARE ENVIRONMENT

Recently there has been a move toward using a
variety of treatment models to ensure quality
while conserving health care resources. Clinicians
must focus on matching patients with appropriate
and specific treatment. The success of clinically
driven treatment relies on an accurate diagnosis
that must take into account severity of addiction.
This can result in

 Placement of patients in the correct level of
care
 Movement to less intensive or more intensive
levels of care when appropriate 
 Matching patients individually to a variety of
treatment models at all case levels
Development of Patient Placement Criteria
The addiction treatment field needs

 Uniform criteria to guide proper patient place
ment
 Guidelines to promote the establishment of
effective individualized treatment modalities
 Data regarding outcomes to continually improve
both the criteria and the guidelines

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8
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

Assessment Follows Theory
Attitudes about assessment across the country
are important. The many and varied beliefs that
exist must give way to a common standard if the
addiction field is to uniformly offer quality care.
The biopsychosocial definition (one that takes into
account biological, psychological and social per
spectives) of addiction provides a framework for
creating uniform assessment standards.

Biopsychosocial Perspective on Addiction 
Understanding addiction as a biopsychosocial ill
ness in its origins, expression, and treatment has
four important results.

1.Promoting the integration of different perspec
tives on the illness
2.Explaining and preserving common clinical
dimensions 
3.Necessitating multidimensional assessment
4.Promoting effective matching of the patient with
individually prescribed treatment
Biopsychosocial Treatment and Matching
Once a uniform model of assessment is agreed
upon, the next step is to define treatment that
matches the severity of the patient's problems.
When a patient is placed in an appropriate level of
care, selection of the specific assessment-based

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The Role of PPC in a Managed Care  Environment 9

model completes the individualized treatment
match.

Levels of Care
The State of Minnesota, the Institute of Medicine
and the American Society of Addiction Medicine
(ASAM) have all established levels of care. 

 By Minnesota standards, patients are placed in
a particular level of care, ranging from residen
tial treatment to outpatient treatment, based on
their level of chemical involvement and other
criteria.
 The Institute of Medicine defines four levels of
care: inpatient, residential, intermediate, and
outpatient.
 The ASAM patient placement criteria describes
four levels of care and are descriptive about the
intensity of service provided: outpatient treat
ment, intensive outpatient treatment/partial
hospitalization, medically monitored intensive
inpatient treatment, and medically managed
intensive inpatient treatment.
Modalities of Treatment
 Biomedical modalities focus on improved
detoxification regimens and treating substance
abuse with medications.

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10
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

 Psychological treatment modalities range from
addiction counseling to psychodynamic and cog
nitivebehavioral treatment modalities.
 Sociocultural treatment modalities include the
community reinforcement approach, family ther
apy, therapeutic communities, vocational reha
bilitation and various other techniques.
Implications
The "retooling" of the addiction treatment system
necessary to promote individualized treatment
requires a shift that has broad implications. If the
shift occurs successfully

 The substance abuse treatment field will devel
op one uniform set of clinically-based place
ment criteria.
 Public- and private-sector programs will develop
a single system of comprehensive care that can
be matched with the placement criteria. 
 Programs will expand their continuums of care
to provide multiple levels of care with flexible
lengths of stay.
 Payers will reimburse and fund all levels of care
to allow patients to be placed in and move
among the most efficient and effective settings.
 Clinicians will become more skilled at compre
hensive assessment and have a broader knowl-

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The Role of PPC in a Managed Care  Environment 11

edge of placement criteria and treatment
modalities.
 Patients will receive care that is not only more
cost efficient but more cost effective.
 As patients receive treatment in the least inten
sive yet safe setting, they can test recovery
skills in situations as close to "real world" condi
tions as possible and minimize reentry prob
lems.
Characteristics of a Comprehensive Set of
Patient Placement Criteria
Client Characteristics
 Age, gender, ethnic, and cultural background
 Severity and course of illness, experiences with
previous treatment
 Relapse potential 
 Need for medical or addiction treatment or
pharmacological, psychiatric, familial, and social
employment
 Need for legal services
 Attitude toward entering and continuing treat
ment
 Effects of environmental and social influences,
such as living situation, family support, and sus
ceptibility to abuse or neglect

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12
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

Service Characteristics
 Intensity of services
 Intensity of environmental support
 Availability of medical services
 Variety of professional disciplines involved
 Availability of services specific to cultural back
ground, age, sex, or disabilities
 Program elements
 Discharge planning
 Patient-to-staff ratio

For more detailed information, see TIP 13, 
pp. 59.

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Building Support for Adopting UPPC 13

BUILDING SUPPORT FOR ADOPTING
UPPC

Benefits of Adopting UPPC
Improving Assessments
 Can be used to take into account the various
dimensions of patient care and to look at the
whole person
 Can become a positive force that assists
providers in looking at the broad range of treat
ment options
 Will guarantee that assessment addresses the
components necessary for successful treatment
 Will require physicians to focus on observable
measures of the severity of illness
 Will provide for the development of more pre
cise screening and assessment instruments
Improving Treatment Planning
 Because of a thorough assessment that identi
fies the patient's strengths and needs, the clini
cian will be able to make better decisions about
the level and models of treatment.
 Continued stay criteria will address why the
patient is staying in treatment and what out
comes are expected.

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Building Support for Adopting UPPC 13

BUILDING SUPPORT FOR ADOPTING
UPPC

Benefits of Adopting UPPC
Improving Assessments
 Can be used to take into account the various
dimensions of patient care and to look at the
whole person
 Can become a positive force that assists
providers in looking at the broad range of treat
ment options
 Will guarantee that assessment addresses the
components necessary for successful treatment
 Will require physicians to focus on observable
measures of the severity of illness
 Will provide for the development of more pre
cise screening and assessment instruments
Improving Treatment Planning
 Because of a thorough assessment that identi
fies the patient's strengths and needs, the clini
cian will be able to make better decisions about
the level and models of treatment.
 Continued stay criteria will address why the
patient is staying in treatment and what out
comes are expected.

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14
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

 Patients can be more effective partners in their
own treatment when the problems being
addressed and the desired outcomes are clearly
articulated.
Economic Benefits
Some managed care systems are finding that
patients are placed into a particular level of care
for treatment services simply because it is avail
able. This is neither cost effective nor beneficial to
the patient. UPPC can promote more efficient con
tracting for services independent of the availability
of treatment slots. An additional clinical and eco
nomic benefit of UPPC is that it will alter less
effective treatment paths that can result from
established referral relationships or other nonclini
cally based referrals.

Establishing a Common Language
Uniform criteria can bring stability and consistency
to the substance abuse treatment field, allowing
diverse disciplines and organizations to work
together. Once implemented, they can provide a
common agenda, a common language, and
shared expectations about treatment across dif
ferent service providers, payers, policy makers
and others. In addition to standardizing terminolo
gy, UPPC can provide a common basis for under
standing the immediate and long-range needs of
patients in treatment. They constitute a frame-

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Building Support for Adopting UPPC 15

work for a variety of groups to use as they engage
in a collaborative planning process, especially
when more than one system is involved (such as
the criminal justice system or human services).

Special Considerations
 Not all areas will have the array of levels of care
described in the criteria. In some cases, criteria
can be adapted to fit the available resources.
 No set of criteria is likely to address the needs
of every client. The implementation of criteria
must allow for flexibility on the part of clinicians
to deviate from the levels of care to address the
needs of the individual client.
 Care must be taken to ensure creativity in pro
gram development is not stifled by PPC. The
substance abuse treatment field is continually
seeking ways to improve programs, and criteria
should not force providers to fit molds or adhere
to rigid descriptions of programs.
Implementing UPPC
A number of important considerations must be
examined when discussing implementation of
UPPC: 

 Tying UPPC to licensing requirements and fund
ing sources

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16
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

 The relationship between UPPC and the actual
range and availability of treatment
 Wraparound services
 Factors that should be addressed for special
populations
 Possible conflicts of eligibility with UPPC
 Elements and goals of assessment
 Assessment instruments and tools
 Strengths and weaknesses of assessment 
settings

For more detailed information, see TIP 13, 
pp. 2340.

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Ethical and Legal Issues 17

ETHICAL AND LEGAL ISSUES

With respect to documenting and supporting sub
stance abuse treatment decisions based on
UPPC, the following recommendations are made:

 Every provider who makes an entry in a
patient's records should do so with the under
standing that it will be reviewed and scrutinized
by the insurer or third-party payers.
 Providers in facilities that have adopted patient
placement criteria must learn to speak the lan
guage of the criteria. The evaluation forms,
progress notes and other components of the
patient's record must relate specifically to the
criteria that use the same terminology.
 The patient record should include specific illus
trations to demonstrate that a patient has been
assessed on a specific dimension outlined in
the criteria and the ongoing attention is focused
on that area. Include specific examples of
observed patient behavior, statements, or histo
ry that clearly indicate treatment resistance.
 Before making an entry, providers should review
previous entries. Conflicting or inconsistent
entries damage the credibility of the entire
record.

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18
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

 While a "defensive" or "patient welfare"
approach to recordkeeping is prudent, the
integrity of patient records should not be com
promised by deliberate misstatements or alter
ations.

For more detailed information, see TIP 13, 
pp. 5155.

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Glossary 19

GLOSSARY OF TERMS

American Society of Addiction Medicine (ASAM):
ASAM is an international organization of 3,000
physicians dedicated to improving the treatment
of persons with substance use disorders by edu
cating physicians and medical students, promot
ing research and prevention, and informing the
medical community and the public about issues
related to substance use. In 1991, ASAM pub
lished a set of patient placement criteria that
have been widely used and analyzed in the sub
stance abuse treatment field.

Assessment: The process of collecting detailed
information about a person's alcohol and other
drug use, emotional and physical health, family
and social problems, roles and supports, educa
tional and employment status, legal status, and
other areas as a basis for identifying the appropri
ate level and intensity of substance abuse treat
ment as well as needs for other services. 

Client: An individual receiving substance abuse
treatment. The terms client and patient are some
times used interchangeably, although staff in
medical settings more commonly use the term
patient.

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20
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

Dimension: A term used in the ASAM patient
placement criteria to refer to one of six patient
problem areas that must be assessed when mak
ing placement decisions.

Healthcare reform: Efforts occurring at the
national, State, and local levels to change the
delivery of healthcare services to meet three
goals: improved access to care, better quality
care, and reduced costs goals that are shared by
those seeking to implement uniform patient place
ment criteria. 

Instrument: A measurement tool, usually a ques
tionnaire, that is used for used for gathering infor
mation about an individual to aid screening,
assessment, diagnosis, and/or clinical decision-
making.

Managed care: An approach to delivering health
and mental health services that seeks to improve
the cost effectiveness of care (i.e., improved serv
ices at reduced cost) by monitoring service seek
ing and delivery. Methods include managing the
overall delivery of care by selecting providers (for
example, health maintenance organizations or
other provider networks) and managing treatment
decisions by individual providers for individual
patients (for example, utilization review).

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Glossary 21

Modality: A specific type of treatment (technique,
method, or procedure) that is used to relieve
symptoms or induce behavior change. Modalities
of substance abuse treatment include, for exam
ple, inpatient social milieu treatment, group thera
py, and individual substance abuse counseling.

Needs assessment: A process by which an indi
vidual or system (e.g., an organization or commu
nity) examines existing resources to determine
what new resources are needed or how to reallo
cate resources to achieve a desired goal. Use of
patient placement criteria can reveal gaps in the
continuum of care and can aid in needs assess
ment at the community and State levels. 

Outcomes monitoring: Collection and analysis of
data from persons in substance abuse treatment
to determine the effects of treatment, especially
in relation to improvements in functioning (treat
ment outcomes monitoring); the same type of
process can be performed at the program level to
determine whether programs are meeting their
goals (program outcomes monitoring). In publicly
supported systems, outcomes monitoring will also
help to establish accountability for the expendi
ture of public funds. 

Patient: An individual receiving substance abuse
treatment. The terms client and patient are some
times used interchangeably, although persons in

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22
The Role and Current Status of Patient Placement Criteria in the
Treatment of Substance Use Disorders

medical settings more commonly use the term
patient.

Rationing: The act of limiting treatment or other
services to certain individuals or populations, usu
ally due to limited resources. 

Third-party payers: Payers for services other than
the client or patient who receives the services,
including private insurance and public payers
such as Medicare and Medicaid.

Utilization review: A method used in managed
care approaches in which an outside organization
reviews clinical decisions in areas such as hospi
tal admission, length of stay, and discharge, as
well as choices regarding placement and treat
ment modality in order to improve the quality of
care and reduce costs. 

Wraparound services: Services in addition to sub
stance abuse treatment that are provided to
patients to improve retention in treatment and
treatment outcomes. 

-----------------------------------------------
Ordering Information
TIP 13 The Role and Current
Status of Patient Placement
Criteria in the Treatment of
Substance Use Disorders

TIP 13-Related Products
KAP Keys for Clinicians based
on TIP 13
Quick Guide for Administrators
based on TIP 13

Do not reproduce or distribute this publication for a fee without spe
cific, written authorization from the Office of Communications,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services.

Easy Ways to Obtain Free Copies 
of All TIP Products
1. Call SAMHSA's National Clearinghouse for Alcohol
and Drug Information (NCADI) at 800-729-6686, 
TDD (hearing impaired) 800-487-4889
2.  Visit CSAT's Website at www.csat.samhsa.gov

-----------------------------------------------
Other Treatment Improvement
Protocols (TIPs) that are relevant to
this Quick Guide:

See the inside back cover for ordering information for all
TIPs and related products.

DHHS Publication No. (SMA) 01-3563
Printed 2001
TIP 8, Intensive Outpatient Treatment for Alcohol
and Other Drug Abuse (1994) BKD139
TIP 11, Simple Screening Instruments for Outreach
for Alcohol and Other Drug Abuse 
and Infectious Diseases (1994) BKD143
TIP 14, Developing State Outcomes Monitoring
Systems for Alcohol and Other Drug Abuse
Treatment (1995) BKD162
TIP 20, Matching Treatment to Patient Needs in
Opioid Substitution Therapy (1995) BKD168
TIP 27, Comprehensive Case Management for
Substance Abuse Treatment (1998) BKD251