education or training in addiction science, and
there are no accepted standards of practice that
apply across facilities and programs.^195
While most states regulate addiction treatment
services, they treat these services as completely
separate and distinct from medical care,* 196 and
state regulations regarding addiction treatment
service requirements vary considerably and tend
to be vague. Accreditors specify required
services in greater detail than state licensing
regulations, as do the federal requirements for
facilities providing opioid maintenance therapy.
State Services Requirements. According to
CASA Columbia’s review, the majority of states
regulate the content of addiction services by
requiring adherence to specific guidelines, but
the extent of the regulation varies considerably.†
In addition to listing the types of required
services, the frequency and timing of services
are specified in some cases; for example,
patients receiving detoxification must receive a
psychosocial assessment within 72 hours of
admission^197 or patients in intensive outpatient
programs must receive individual or group
therapy for a minimum of six hours over at least
two days a week.^198
More than 30 states require addiction treatment
programs and facilities to utilize the American
Society of Addiction Medicine (ASAM) patient
placement criteria, which guide providers in
matching patient needs to specific treatment
services and determining the appropriate level of
care for patients.^199
State regulations related to addiction treatment
services tend to specify the categories of
services that addiction facilities and programs
must offer--such as individual, family and group
- Except for opioid maintenance therapy and some
detoxification services, which are considered medical
care and must be supervised by a physician.
† Regulations were considered to provide detailed
guidelines if they included, for example, specific
pharmaceutical dosing schedules or specific
assessment criteria (e.g., including onset/duration of
problems, previous interventions/outcomes, health
history/current medical care needs and daily living
skills).
counseling; alcohol and other drug education;
activity therapy and social services^200 --but are
not particularly specific in requiring that the
services follow evidence-based practices. A
survey conducted in 2006 found that three
states--Oregon, North Carolina and Alaska--
have enacted legislation that mandate or
encourage the use of evidence-based practices in
addiction treatment programs; only Oregon
mandates programs to implement evidence-
based practices under penalty of fiscal
sanctions.^201 However, the reach of the Oregon
law is limited to programs and facilities that are
funded by the state.‡ 202Federal Services Requirements. The federal
regulations for opioid maintenance therapy
programs include specific admission criteria,
services and procedures for patient care.
Admission is limited to patients who meet
clinical diagnostic criteria for opioid
dependence§ and the person must currently have
addiction and must have become addicted within
one year before treatment admission.** A
physician must perform a full medical
examination before admission. Opioid
maintenance therapy programs must provide
medical care, addiction counseling, vocational
and educational services and other assessment
and treatment services. The regulations stipulate
that random testing for addictive drugs must be
performed on all patients periodically;†† that
treatment medication dosing must be calculated
by a physician familiar with the “most up-to-
date” labeling; and that for patients receiving‡ The Department of Corrections, the Oregon Youth
Authority, the State Commission on Children and
Families and the part of the Oregon Health Authority
that deals with mental health and addiction issues.
§ Determined using accepted clinical criteria, such as
those in the DSM-IV.
** The one-year requirement may be waived for
persons released from penal institutions (within six
months after release), pregnant women (a program
physician must certify pregnancy) or previously-
treated patients (up to two years after discharge).
†† All patients are to be drug tested initially and then
eight times per year for patients in maintenance
treatment and monthly for persons receiving long-