Treatment matching. Theoretic basis and practical implications.

An extensive knowledge base supports the development of treatment matching methods for alcohol and other drug abuse. Many matching variables have been identified that relate to specific modalities of treatment and to specific levels of care. Physicians and other providers can use many putative matching variables to address patients' substance use problems on a highly individualized basis. These variables include demographic factors (age, gender, culture), typology and severity (age of onset; severity of intoxication; withdrawal; quantity, recency, frequency of substance use), intrapersonal characteristics (psychiatric diagnosis, cognitive function, self-efficacy, stage of change), and interpersonal function (social stability). The evolution of formal criteria for patient placement such as the ASAM criteria is a beneficial, adaptive process that is underway in numerous states, managed care entities, professional provider societies, and provider groups. Currently, matching approaches rely more heavily on consensus recommendations than on empiric matching data. The technology for conducting psychosocial treatment matching studies is rapidly increasing in sophistication. Although predictive validity has not yet been fully demonstrated on a large, multisite basis, the national research portfolio on treatment matching is expanding in size and complexity. This is an essential public health need, given dramatic cost pressures, if addiction services are to continue to grow in quality and availability.