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BAM-IOP and BAM-RIntensive Outpatient Assessment.
The primary purpose of the Brief Addiction Monitor (BAM) is to support individualized, measurement-based care for substance use disorders (SUD). The BAM monitors a patient’s progress in SUD care and yields reliable data that is both easy to collect and readily integrated into SUD treatment planning.
The BAM is a 17-item, multidimensional questionnaire, designed to be administered as a clinical interview (in-person or telephonically) or via patient self-report, for all patients seeking or enrolled in SUD specialty care. It retrospectively assesses the past 30 days of three SUD-related domains: risk factors for substance use, protective factors that support sobriety, and drug and alcohol use. Items were selected for inclusion in the BAM based on their presence in existing SUD measures and/or on empirical support for their reliable and valid assessment of SUD relapse risk and treatment outcome. Each item ranges in value from zero to 30, the Use Score ranges from zero to 90, and the risk and protective factor scores range from zero to 180.
Two studies have been done on the psychometric properties of the BAM. The first study made use of the continuous item version of the BAM (Cacciola et al., 2012). This study found support for the factor structure, internal consistency, test-retest reliability, and sensitivity to change of the BAM. BAM scores collected at intake also predicted treatment completion vs. dropout.
The second study (Nelson, Young, & Chapman, 2013) used a version of the BAM with a Likert-scale rather than continuous items. Although this study found that the BAM lacked a reliable factor structure, it did find some evidence supporting the use of individual BAM items.
In a third study (Chih et al., 2014), BAM scores obtained weekly from a smartphone application over an 8-month period significantly predicted relapse status within the week following the assessment. End-users are strongly encouraged to attend to the item-level data (rather than the three-factor scores) because they have direct implications for treatment planning. That is, they identify specific areas of need or resources the patient brings to bear in his/her recovery. The BAM is widely used in VA medical centers, has been selected for inclusion in the VA’s measurement-based care in mental health initiative, and it is also being used in several branches of the military.
Implementing an adaptive treatment requires an appropriate patient monitoring protocol. The BAM can potentially serve as a tool within such a protocol. Important additional steps in the implementation of the BAM or other such instruments include the development of electronic versions, which can facilitate the assessment process by providing clinician prompts concerning when assessments are due and the latest patient contact information. Additionally, automated clinical status and progress reports that provide current status and longitudinal, individual patient-level data would support the clinical utility of the measure. Similarly, automated aggregate reports would be an enhancement for management and executive staff.