KAP KEYS Based on TIP 13 

The Role and Current Status of Patient 

Placement Criteria in the Treatment of 

Substance Use Disorders 

CSAT’s 

Knowledge Application Program 

KAP Keys

For Clinicians
 

Based on TIP 13 

The Role and Current 

Status of Patient Placement 

Criteria in the 

Treatment of 

Substance Use 

Disorders 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 
KAP KEYS Based on TIP 13 

The Role and Current Status of Patient Placement Criteria in 

the Treatment of Substance Use Disorders 

Introduction 

These KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration. These KAP Keys are 

based entirely on TIP 13 and are designed to meet the needs 

of the busy clinician for concise, easily accessed "how-to" information. 

For more information on the topics in these KAP Keys, readers 

are referred to TIP 13. 

Other Treatment Improvement Protocols (TIPs) 

that are relevant to these KAP Keys: 

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 
KAP KEYS Based on TIP 13 

The Role and Current Status of Patient Placement Criteria in 

the Treatment of Substance Use Disorders 

Selected Terms 1 

Biopsychosocial: A holistic approach to assessment and treatment that takes into account a person's medical (biological), 

psychological, and social needs. This approach reflects the 

understanding that addiction affects the whole person and is 

influenced by a wide range of factors. 

Bundling: An approach to treatment that ties or "bundles" several treatment services together, often delivering them in a 

specific treatment setting. Because this approach often overlooks a patient's individual needs and can lead to inappropriate and unnecessary service provision, the current trend is 

toward unbundling services, a more flexible approach. 

Continuum of care: A structure of interlinked treatment modalities and services that is designed so that individuals' changing 

needs will be met as they move through the treatment and 

recovery process. 

Dual diagnosis: A diagnosis that includes a concurrent substance use disorder(s) and a psychiatric disorder(s). 

Eligibility criteria: Factors which determine whether a patient 

may receive treatment. These include: financial status, insurance coverage, age, severity of illness, geographic location, 

and whether a patient is a member of a special population. 

Intensity of service: The degree or extent to which a treatment 

or service is provided, which depends on a patient's level of 

need. Some treatments, for example, medically managed inpatient treatment, are inherently more intensive than other treatments, for example, outpatient treatment or a halfway house. 

The provision of other services, such as vocational training, 

can be more or less intense, depending on patient needs. (See 

level of care.) 

Level of care: As used in the ASAM criteria, this term refers to 

four broad areas of treatment placement, ranging from inpatient to outpatient. Other levels of care within this range, such 

as therapeutic communities, have been described in other criteria. 

Matching: A process of individualizing treatment resources to 

a patient's needs and preferences based on careful assessment. Matching has been shown to increase treatment retention, and thus improve treatment outcomes. It also improves 

resource allocation by ensuring that patients receive the appropriate level of care and intensity of services. (See continuum of 

care, unbundling.) 

Continued on back 
KAP KEYS Based on TIP 13 

The Role and Current Status of Patient Placement Criteria in 

the Treatment of Substance Use Disorders 

Patient placement criteria (PPC): Standards of, or guidelines 

for, substance abuse treatment that describe specific conditions under which patients should be admitted to a particular 

level of care (admission criteria), under which they should continue to remain in that level of care (continued stay criteria), 

and under which they should be discharged or transferred to 

another level (discharge/transfer criteria). PPC generally 

describe the settings, staff, and services appropriate to each 

level of care and establish guidelines based on substance 

abuse diagnosis and other specific areas of patient assessment. 

Placement: Selection of an appropriate level of care, based on 

assessment of individual needs and preferences. 

Setting: A specific place in which treatment is delivered. 

Settings for substance abuse treatment include hospitals, 

methadone clinics, community mental health centers, and prisons or jails. 

Unbundling: An approach to treatment that seeks to provide 

the appropriate combination of specific services to match a 

patient's needs. The goal of unbundling is to provide an array 

of options for flexible individualized treatment, which can be 

delivered in a variety of settings. 

Uniform Patient Placement Criteria (UPPC): A set of patient 

placement criteria, not yet developed, that would provide 

national standards for assessing and treating patients with 

substance abuse disorders and that would be used by all 

providers in the public sector and private sector. 
Why Use Placement Criteria? 2 

KAP KEYS Based on TIP 13 

The Role and Current Status of Patient Placement Criteria in 

the Treatment of Substance Use Disorders 

• Promotion of quality, individualized care 

• Improved quality of assessment 

• More multidimensional treatment plan 

• Cost effective treatment 

• Eventual economic benefits for providers 

• Establishment of a common language 

• Treatment outcomes more readily evaluated 

• Identification of gaps in the continuum of care 

• Identification of the elements to effective programs 

• Opportunity for focused research studies on treatment and 

cost effectiveness 

• Establishment of generally accepted practice in the substance abuse treatment field, may prevent litigation 
KAP KEYS Based on TIP 13 

The Role and Current Status of Patient Placement Criteria in 

the Treatment of Substance Use Disorders 

Variables Considered in 

Assessing and Placing a Client 

3 

Assessment Variables 

Patient Preference 

Diagnosis

Prior Treatment 

Course of Illness 

Response 

Mental Status 

Family History 

• Assessment variables are general characteristics that form 

the first level of data for input to decision rules. 

• Matching variables are the specific data elements that are 

level of care. then required for multidimensional matching to a discrete 

• Modifying variables may be used to modify the level of care 

the patient or treatment system determination based on intervening factors that exist within 

Matching Variables 

Intoxication/Withdrawal 

Biomedical Conditions

Psychological Conditions 

Treatment Readiness 

Relapse Potential 

Environmental Status 

Modifying Variables 

Age 

Gender

Sexual Orientation 

Service Availability/Access 

Culture/Language/Ethnicity

Childcare/Eldercare 

Patient Preference 

T 

N

E

M

E

C

A

L

P
KAP KEYS Based on TIP 13 

The Role and Current Status of Patient Placement Criteria in 

the Treatment of Substance Use Disorders 

What Issues Must Be Addressed 

By the UPPC of the Future? 

4 

An important area that must be considered in the creation of 

uniform patient placement criteria (UPPC) is the need to keep 

the criteria flexible and amendable. There are dangers in structuring treatment of any kind according to a defined set of criteria. Treatment must remain flexible to meet patients' individual

needs and incorporate evolving modalities of care. Clinicians 

must remain able to exercise judgment in all cases. In addition, if a single approach to care is widely adopted and strictly 

adhered to as the "correct" approach, treatment innovation 

may be stifled. The chief value of any criteria set is the added 

power it gives providers to identify specific patient needs by 

means of a consistent and detailed assessment process, and 

to choose a level of care that will specifically address those 

needs. 

Future criteria must be flexible and amendable. 

Clinicians must remain able to exercise judgment 

in all cases. 

To focus on the criteria themselves and forget their goal—placing patients in appropriate levels of care—is to value the rules 

above the process and to make a rigid approach to the complex 

biopsychosocial problem of substance abuse and dependence. 

The principles of the criteria will outlast any single criteria set. 

No matter how comprehensive a uniform set of criteria is, 

individual providers will modify criteria to fit the needs of the 

specific patients and populations they serve. 
Why Develop Various Treatment 5 

Models? 

KAP KEYS Based on TIP 13 

The Role and Current Status of Patient Placement Criteria in 

the Treatment of Substance Use Disorders 

Within the U.S., there has been just one major approach to 

treatment, based on the Alcoholics Anonymous 12-Step philosophy and the fixed length of inpatient stay pioneered in 

Minnesota. This treatment approach, with its inpatient treatment philosophy, has been more commonly used for treating 

substance abuse than any other approach. This is the treatment model that has been used—in a "one size fits all" 

approach—for all patients who meet the criteria for treatment. 

Today, in the treatment field, there is a movement toward using 

a variety of treatment models to ensure access to quality treatment and conserve health care resources. Now clinicians must 

focus on matching patients to appropriate, specific treatment, 

rather than on placing patients in established programs. The 

success of clinically driven treatment depends on the importance of an accurate diagnosis. However, it is not only a diagnosis of addiction, but also of the severity of addiction, that 

must determine the kind of treatment an individual patient 

should receive. This determination can result in: placement of 

patients in the correct level of care, movement to less intensive or more intensive levels when appropriate, and matching 

patients individually to a variety of treatment modalities at all 

levels of care. 

Implicit in this scenario is the existence of many types of treatment programs, such as narcotic addiction treatment, and outpatient and residential settings within a community. Also 

implicit is the growth of a variety of treatment approaches creatively developed to address underserved populations and less 

than adequate outcomes. 
Ordering Information
 

TIP 13 

The Role and Current Status of Patient
 

Placement Criteria in the Treatment of
 

Substance Use Disorders
 

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 Web site at www.csat.samhsa.gov 

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services. 

DHHS Publication No. (SMA) 01-3565 

Printed 2001