An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement.
An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement.
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以 ASAM 患者安置标准为指导改变烟草治疗方案的论据。
DOI：
10.1097/adm.0000000000000239
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发表时间：
2016
影响因子：
5.5
通讯作者：
Burke,MichaelV
中科院分区：
文献类型：
--
作者：
Williams,JillM;Steinberg,MarcL;Kenefake,AlexandraN;Burke,MichaelV
烟草使用是美国公共卫生的主要威胁，也是可预防死亡的头号原因。虽然大多数吸烟者试图在没有帮助的情况下戒烟，但强有力的数据表明，将行为支持与美国食品药品监督管理局批准的戒烟药物配对，可显著提高戒烟率。那些在戒烟方面得到帮助的人通常只接受非常低强度的治疗，而不管他们的依赖程度或医疗和环境情况如何。这与其他物质使用障碍的治疗方式形成鲜明对比，在其他物质使用障碍中，根据成瘾的严重程度和生物心理社会环境，有不同程度的护理。美国成瘾医学会（ASAM）开发了一种正式的算法，用于评估物质使用障碍并确定最佳护理水平。ASAM患者安置标准经常用于确定除烟草外的所有物质使用障碍的适当护理水平。本文将审查ASAM的护理和安置水平的维度的关键方面，重点是它们如何适用于烟草使用和目前的典型吸烟者谁将受益于更高强度的烟草依赖治疗的案例。我们还提出了目前的障碍，以偿还这些服务的医疗保健提供者。最后，我们的评论和讨论有关改善烟草依赖治疗护理的建议。
Tobacco use is a major threat to public health in the United States, and the number one cause of preventable death. Although most smokers try to quit unaided, robust data indicate that pairing behavioral support to US Food Drug Administration-approved cessation medications significantly increase cessation rates. Those who do receive assistance in quitting usually receive very low intensity treatment, regardless of the severity of their dependence or their medical and environmental circumstances. This is in stark contrast to how other substance use disorders are treated, where there are varying levels of care depending on addiction severity and biopsychosocial circumstances. The American Society of Addiction Medicine (ASAM) developed a formal algorithm for assessing substance use disorders and determining the optimal level of care. The ASAM Patient Placement Criteria are regularly used to determine the appropriate level of care for all substance use disorders except tobacco. This paper will review key aspects of the ASAM dimensions of care and placement levels, with emphasis on how they apply to tobacco use and present case examples of typical smokers who would benefit from a higher intensity of tobacco dependence treatment. We also present current barriers to reimbursing healthcare providers for these services. We conclude with a commentary and discussion regarding recommendations for improvements in tobacco dependence treatment care.