Individualized Treatment with the DAPPER-3

Individualized treatment does not imply that a wholesale modification of a treatment program is required to tailor treatment to the specific needs and strengths of a given individual. What individualized treatment requires is a sufficiently detailed assessment of the individual to appropriately set priorities and goals for aspects of treatment.

The current ASAM Criteria and its predecessors developed a dimensional approach to organizing the assessment. The current criteria have six dimensions each containing a variety of constructs that are suggested for assessment in developing individualized treatment plans. The six dimensions are Intoxication/withdrawal potential; Biomedical conditions; Emotional/behavioral/cognitive conditions; Readiness to change; Relapse/Continued use/continued problem potential; and Recovery environment.

The DAPPER-3 (Dimensional Assessment for Patient Planning Engagement and Recovery – 3) was developed in conjunction with David Mee-Lee, M.D. and Jerry Shulman, M.A., M.A.C. who were the chief editors for the more recent version of the ASAM Criteria. The DAPPER-3 provides a series of ratings on a five-point scale (0 to 4) for the various constructs within each dimension with the higher the rating the more serious or higher priority the construct. For example, in the dimension of Readiness to Change, there are ratings regarding the understanding the individuals have of their condition, commitment to making changes and other ratings related to the strengths or risks involved within this dimension.

Although the DAPPER-3 has been available for years in paper form, Evince Diagnostics, LLC has taken the step to place the ratings online to facilitate more consistent administration and useful feedback of findings via a HIPAA compliant website: The system presents the ratings to be done and flags all ratings of 3 or 4 to call attention to constructs that may be more urgent or that may indicate a priority for treatment planning or adjustments of the treatment plan.

Up to six assessments can be made on the same individual over time to document whether there are indications of improvement or not. Specific areas might show improvement while others might remain constant or even show indications of worsening problems.

Thus, the online DAPPER-3 may be a key aid in not only initial planning for individualized treatment, but also a means of monitoring progress during treatment to indicate expected progress or the possible need to adjust the treatment plan.