American Society of Addiciton Medicine

Release Notes – March 2024


CONTINUUM Level of Care Output – Sustained Remission

The Summary and Narrative Report Final Level of Care Recommendations will now include personalized output for patients in sustained remission from substance use disorder (i.e., they have not met any DSM-5-TR criteria for substance use disorder (besides craving) in the past 12 months.

  • NOTE: As per The ASAM Criteria, Level 1 is recommended for ongoing remission monitoring.
  • If the patient also needs service coordination for psychiatric, biomedical, or housing needs, the output will specify those needs.



  • For patients who meet diagnostic criteria for sustained remission, but report substance use within the past 30 days, the Summary Report’s Diagnostic Findings section will display an asterisk with an associated message: “Recent substance use was reported.” This modification will alert the clinician that recent use may destabilize the patient’s remission. 



  • For patients in sustained remission who have used any substance in the past 30 days, the Final Level of Care Recommendations will also indicate a potential need for escalation beyond Level 1 services: 


CONTINUUM Level of Care Output – Level 2.1 + 3.1

We are introducing a new recommendation in the Summary and Narrative Reports, Final Level of Care Recommendations section, for Level 2.1 + 3.1 to further personalize CONTINUUM results.

  • This new recommendation is appropriate for patients who meet dimensional admission criteria for Level 2.1 (i.e., they need 9 to 19 clinical service hours per week) but also require a residential component because their living situations or recovery environments are incompatible with their recovery goals.
  • Patients may now receive a Final LOC recommendation for:
  • Level 2.1+ Level 3.1;
  • Level 2.1 Co-Occurring Capable (COC) + Level 3.1; or
  • Level 2.1 Co-Occurring Enhanced (COE) + Level 3.1.


CONTINUUM Level of Care Output – Opioid Treatment Services for MOUD Taper

We are also introducing new output in Final Level of Care Recommendations for Opioid Treatment Services (OTS) for patients who will undergo an opioid agonist taper and need assessment and treatment of associated withdrawal symptoms.

  • This new output will provide context for an OTS recommendation when the clinician indicates that a patient will be gradually withdrawn from a medication for opioid use disorder (MOUD) such as buprenorphine or methadone.

Co-Triage Level of Care Output: Level 2 for Withdrawal Management Needs

  • The CO-Triage report now includes new output for patients meeting provisional criteria for Level 2 due to withdrawal management needs.
    • Patients who would otherwise meet provisional criteria for Level 1 but have withdrawal management needs that require extended nurse monitoring, will now receive a recommendation for Level 2.
      • The new output will specify the patient’s need for withdrawal management evaluation at a Level 2 program:


      • If applicable, the output will also specify the patient’s need for assistance with shelter, transportation, or mobility to enable outpatient treatment attendance:


    CONTINUUM Narrative/Summary Report Output: Diagnostic Findings                                   

    To improve alignment with the DSM-5-TR, we have updated the Narrative and Summary Report Diagnostic Findings table to reflect drug class diagnoses.

  • Drug class diagnoses will output for opioids, stimulants, and sedative/hypnotics, for example, when a patient meets one DSM-5-TR criterion in each of two drug categories in the same drug class.
    • For instance, if a patient meets one criterion in “heroin/fentanyl” and another criterion in “other opioids”, they will receive an opioid use disorder diagnosis.
    • The DSM-5-TR Substance Use Disorder(s) table will display this diagnosis under the new “Drug Class” section.

     

    CONTINUUM Interface Update - ASdMAT

    • A new question in the Drug and Alcohol section, Addiction Treatment History subsection, prompts interviewers to ask, “Have you been taking ongoing medication for addiction treatment?” (ASdMAT).
      • Interviewers will be able to indicate if the patient is taking ongoing medication for alcohol use disorder, opioid use disorder, or nicotine use disorder.
      • This question will be used to inform new decision logic for sustained remission diagnoses and associated level of care output.  

    CONTINUUM Interface Update – Illicit versus prescribed fentanyl (SubsUse)

    • In the Drug and Alcohol section, we have refined response options for the SubsUse question: "Which substances have you had problems with?" to better distinguish between illicit versus prescribed fentanyl.
      • “Heroin/fentanyl” has been changed to "Heroin/illicit (street) fentanyl."
      • The response option for other opioids has been updated to: "Opioid or narcotic other than heroin, methadone, or buprenorphine, even if by prescription, including prescribed fentanyl." 

    CONTINUUM Interface Update – ASd25f

    We have also introduced a new Warning message in the Drug and Alcohol section, Opioid Treatment Services subsection, to emphasize the importance of MOUD (medication for opioid use disorder) as the preferred approach for treating heroin or opioid withdrawal symptoms.

    • Users will now receive a Warning message for item ASd25f if they select “Withdrawal management with no medication” AND the patient reports recent, frequent opioid use and/or current opioid withdrawal symptoms.


    CONTINUUM Interface Update – ASd25g

    In response to a help desk ticket, we have revised the wording of question ASd25g within the Drug and Alcohol section, Opioid Treatment Services subsection. This update aims to enhance the accuracy of user responses.

    • Previous question text: Is the patient to be or being gradually withdrawn from Opioid Treatment Services (OTS)?
    • Updated question text: Is the patient about to be withdrawn or is the patient being gradually withdrawn from Opioid Treatment Services (OTS)? 123


      CONTINUUM Interface Update – Revision of DSM-5-TR Items

      We have revised the DSM-5-TR questions to enable SUD diagnoses of early and sustained remission.

      • "Early remission" means that symptoms other than craving have been absent for at least the past 3 months, but less than 12 months.
      • "Sustained remission" means that symptoms other than craving have been absent for 12 months or longer.

    For each DSM-5-TR criterion, users can select from four options to specify the time frame in which the patient experienced that symptom:                                      

    1. No
    2. Yes, but not in the last year
    3. Yes, in the last year, but not in the last 3 months
    4. Yes, in the last 3 months
    5. Yes, even currently (in the last few days) *

      * This response, “yes, even currently (in the last few days),” only appears as an option for the DSM-5-TR question related to withdrawal, which asks if the patient has gotten physically sick when they stop using or continued to use to prevent getting sick (CUAXxx02).

     

  • User Release - Previous Updates

    Version 3.27 Release (February 13, 2024)
    Version 3.25 Release (October 24, 2023)
    Version 3.24 Release (September 12, 2023)