Chapter 8 Subset of Overview by Substance Use Severity

Chapter 8Subset of Overview by Substance Use Severity

GAIN Coordinating Center (11/21/2012).

Normal, IL: Chestnut Health Systems. November 2012. Available from www.gaincc.org/slides

Created for: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for

Substance Abuse Treatment (CSAT) under contract number 270-2012-00001

http://www.gaincc.org/slides

2

SAMHSA/CSAT Full GAIN Outcome Data Set

Sample: The 2011 SAMHSA/CSAT data set includes data on 29,782 clients from 230 local evaluations, recruited between 1997-2011 who were due for at least one follow-up and available in the last quarterly data set of 2011.

Levels of Care: Outpatient, Intensive Outpatient, Short-term & Moderate/Long-term Residential, Corrections-Based Treatment and Post-Treatment Continuing Care

Instrument: Global Appraisal of Individual Needs (GAIN) (see www.gaincc.org/gaini) Versions 3 (CYT & ATM) and 5.1 through 5.6

Follow-up: 89% with one or more follow-ups at 3, 6, 9 & 12 months post intake, and 66% with two or more

Funding: SAMHSA/CSAT contracts 270-07-0191 and 270-2012-00001 and 230 individual grants

(see Detailed Acknowledgement)

http://www.gaincc.org/gaini

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Past Year Substance Use Severity

Past Year Dependence

47.9% (n=14,058)

No Past Year Use 1.1% (n=316)

Past Year Use

21.6% (n=6,355)

Past Year Abuse 29.4%

(n=8,629)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,358)

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Risk and Protective Factors by Substance Use Severity

The following slides present information on demographics, and risk and protective factors by different age groups for clients at intake, including: Demographics Substance use Risk behaviors Victimization Mental health disorders Physical health problems Crime and violence Sources of stress and strengths Costs Summary indices (problem prevalence, quality of life, general satisfaction) Non-client characteristics (program, level of care, and type of treatment)

5

Age by Substance Use Severity

No PY Use PY Use PY Abuse PYDe-pen-

dence

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3%17%

4% 10%6%

17%

10%14%

45%

53%

70%65%

47%

13% 16% 12%

<15

15-17

18-25

26+


6

Gender by Substance Use Severity

No PY Use PY Use PY Abuse PY De-pen-

dence

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

37%27% 22%

31%

63%73% 78%

69% Male

Female


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Race by Substance Use Severity


dence

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

28% 24% 18%10%

26% 27%28%

30%

9%3%

4%4%

22% 33% 37%42%

16% 12% 13% 14%Multi-Racial

White

Other

Hispanic

African American


8

8

Risk of Homelessness by Substance Use Severity

No PY Use PY Use PY Abuse PY De-pendence

0%10%20%30%40%50%60%70%80%90%

100%

81%72%

84%70%

2% 3% 2% 6%Currently Homeless

At Risk of Homeless-ness

Group/Inst

Housed


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Primary Substance by Substance Use Severity


dence

0%10%20%30%40%50%60%70%80%90%

100%

99%

39%27% 21%

44% 66%

54%

Other Drug

Opioids

Amphetamines

Cocaine

Marijuana

Alcohol


10


0%10%20%30%40%50%60%70%80%90%

100% 2%

49%High SU (6-8)

Moderate SU (3-5)

Low SU (0-2)

Number of Substance Problems by Substance Use Severity


11


0%10%20%30%40%50%60%70%80%90%

100% 5%26% 35%

47%Dependence/Daily Use

Current PY Use

Past Use

Never Used

Tobacco Diagnosis by Substance Use Severity


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HIV Risk Scale* by Substance Use Severity

* Available at intake only.


0%10%20%30%40%50%60%70%80%90%

100% 5% 9% 11%31% High

Risk(10-36)

Moderate Risk(3-9)

Low Risk(0-2)


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HIV Risk Change Index* bySubstance Use Severity


0%10%20%30%40%50%60%70%80%90%

100% 1% 2% 6% 14%HighRisk(4-7)

ModerateRisk(2-3)

LowRisk(0-1)

*Can be used to measure change.


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Number of Sex Partners* by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100% 4% 9% 16% 18%3+ Sex Partners

1-2 Sex Partners

No Sex Partners

*In the past 90 days


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Severity of Victimization by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%

27% 35% 35%58%

High Severity (4-15)

Moderate Severity (1-3)

Low Severity (0)


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Mental Health Disorders by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%16% 13% 18%

51%

Both

Internalizing Disorders Only

Externalizing Disorders Only

Neither


17


0%10%20%30%40%50%60%70%80%90%

100% 2% 1% 1% 5%High Severity(4-5)

Moderate Severity (1-3)

Low Severity (0)

Homicidal/Suicidal Thoughts by Substance Use Severity


18

Health Problems by Substance Use Severity


dence

0%10%20%30%40%50%60%70%80%90%

100% 5% 7% 6% 11%High Prob-lems(33-100)

Moderate Problems (10-32)

Low Prob-lems(0-9)


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Health Care Utilization Cost* by Substance Use Severity


dence

0%10%20%30%40%50%60%70%80%90%

100%

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$1,591$1,786

$1,543

$3,475 $7,600+

$1 - $7,599

$0

Mean

SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,481)*Using 2011 Dollars

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Crime & Violence by Substance Use Severity


dence

0%10%20%30%40%50%60%70%80%90%

100%12% 14%

29%49%

High Crime(7-29)

Moderate Crime (3-6)

Low Crime(0-2)


21

Type of Crime by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%19% 18%

34%49%

Violent Crime*

Other Crime**

Drug Use only


* Violent crime includes assault, rape, murder, and arson.** Other crime includes vandalism, possession of stolen goods, forgery, and theft.

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Cost of Crime* by Substance Use Severity

*Using 2011 Dollars


No PY Use

PY Use PY Abuse PY De-pen-

dence

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

$900,000

$46,509 $75,162

$453,909

$803,317

$120,000+

$1-$119,000

$0

Mean

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dence

0%10%20%30%40%50%60%70%80%90%

100% Detention/jail 30+ daysDetention/jail 14-29 daysDrug CourtProb/parole 14+ days w/ 1+ drug screensOther probation, parole, detentionOther JJ/CJ statusPast arrest/JJ/CJ sta-tusPast yr illegal activ-ity/SA use

Intensity of Justice System Involvement by Substance Use Severity


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Count of Major Clinical Problems* at Intake by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%13% 18%

31%

70%

Five to Twelve

Four

Three

Two

One

None

*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity


25


0%10%20%30%40%50%60%70%80%90%

100%

27% 27% 28%49%

High Stress(3-15)

Moderate Stress(1-2)

Low Stress(0)

Sources of Stress Index by Substance Use Severity


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0%10%20%30%40%50%60%70%80%90%

100% 6% 5% 6% 4%Low Readiness (0-2)

ModerateReadiness (3-5)

High Readiness (6-9)

Treatment Readiness by Substance Use Severity


27

Self-Help Activities by Substance Use Severity


dence

0%10%20%30%40%50%60%70%80%90%

100%

94%76%

88%

64%

Low Activ-ity (0)

Moderate Activity (1-11)

High Activ-ity (12-19)


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0%10%20%30%40%50%60%70%80%90%

100%11% 9% 7% 7%

Low Strength(0-2)

Moderate Strength (3-6)

High Strength (7-10)

Strength Self-Efficacy Index by Substance Use Severity


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0%10%20%30%40%50%60%70%80%90%

100%12% 10% 6% 4%

Low Support(0-1)

Moderate Support (2-4)

High Support(5-9)

General Social Support Index by Substance Use Severity


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Spiritual Social Support by Substance Use Severity


dence

0%10%20%30%40%50%60%70%80%90%

100%

51% 44%57% 51%

Low Support (0-2)

Moderate Support (3-5)

High Support (6-7)


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0%10%20%30%40%50%60%70%80%90%

100% 7% 11% 7% 7%Low Strength(0-2)

Moderate Strength (3-5)

High Strength(12-16)

Environmental Strengths Index by Substance Use Severity


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No PY Use

PY Use PY Abuse PY De-pen-

dence

0%10%20%30%40%50%60%70%80%90%

100%

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000

$3,000 $4,199

$3,562

$6,149

$10,000+

$2,000 - $9,999

$0-$1,999

Mean

Quarterly Cost to Society* by Substance Use Severity

*Using 2011 DollarsSAMHSA 2011 GAIN Summary Analytic Data Set (n=26,349)

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Problem Prevalence Index by Severity of Victimization

Low Severity

Moderate Severity

High Severity

0%10%20%30%40%50%60%70%80%90%

100% 2% 5% 13%High Preva-lence(25-100)

Moderate Prevalence (6-24)

Low Preva-lence(0-5)


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0%10%20%30%40%50%60%70%80%90%

100% 7% 5%19%

55%

Low Quality (0-36)

Moderate Quality (37-69)

High Quality(70-100)

Quality of Life by Substance Use Severity


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General Satisfaction by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%17% 15% 9% 17%

Low (0-2)

Mod. (3-4)

High (5-6)

*GSI groups are usually reversed (low satisfaction scores (0-2) are in the high problem group); here low satisfaction scores are in the low group, and high satisfaction scores are in the high group.SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,165)

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Program by Substance Use Severity


dence

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%ATMARTCYTYORPORPATDCSCYAAFTDCEATTCEOther


37

Level of Care by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%

79% 75% 79%64%

12% 14% 11%

13%

3% 8% 5%8%

6% 3% 5%13%

2%

STR

M-LTR

CC-OP

IOP

OP


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Type of Treatment by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%

47% 39% 44%30%

24%14% 10%

9%

24%

25% 28%

30%

5%19% 13%

21%

2% 5% 10%Tx Man

Other

ACRA/ACC

Other EBTx

MET/CBT


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Outcomes The following slides present information on the outcomes of

substance abuse treatment by substance use severity, including: Abstinence Recovery GPRA outcomes (vocationally engaged, housed, no justice

system involvement, social consequences, abstinence, and social connectedness) and

NOMS outcomes (treatment initiation, engagement and continuing care; no problems with: health, mental health, family, illegal activity; abstinent, vocationally engaged and housed).

Data on follow up rates, months to last follow up, and number of follow ups per client are provided in the Methods

Appendix.

http://gaincc.org/_data/files/Posting_Publications/19._Methods_Appendix_2011.pptx

http://gaincc.org/_data/files/Posting_Publications/19._Methods_Appendix_2011.pptx

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Percent Change in 6 Month Abstinence by Substance Use Severity


-20%

0%

20%

40%

60%

80%

100%

-6%

9%

26% 21%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=19,904)

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Relative Percent Change in 6 Month Abstinence by Substance Use Severity


-20%

0%

20%

40%

60%

80%

100%

-6%

13%

73%61%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=19,904)

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Past Month AOD Abstinence by Substance Use Severity

Intake 3 Month 6 Month 9 Month* 12 Month0%

10%20%30%40%50%60%70%80%90%

100%

No PY Use

PY Use

PY Abuse

PY De-pendence

*InterpolatedSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

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Recovery* by Substance Use Severity

Intake 3 Month 6 Month 9 Month** 12 Month0%

10%20%30%40%50%60%70%80%90%

100%

No PY Use

PY Use

PY Abuse

PY De-pendence

* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups **Interpolated

44In

take

Last

W

ave

Inta

ke

Last

W

ave

Inta

ke

Last

W

ave

Inta

ke

Last

W

ave0%

10%20%30%40%50%60%70%80%90%

100%Vocationally Engaged

Housing

No Justice Sys-tem Involvement

No Social Consequences

Abstinence

Socially Connected

Change in GPRA Outcomes by Substance Use Severity (Intake to Last Wave*)

No PY Use PY Use PY Abuse PY Dependence

*Last wave is the last follow-up

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

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NOMS Outcome: Number of Treatment Received Outcomes Met* by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%

40% 32% 32% 28%

29% 39% 40% 42%

None

One

Two

Three

Four

*Based on a count of initiation within 14 days, evidence based practice, engagement for at least 6 weeks, and any continuing care.SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=24,313)

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SAMHSA Outcome: Treatment Cost Bands by Substance Use Severity


0%10%20%30%40%50%60%70%80%90%

100%

66%49% 53% 44%

Above

Within

Below

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=17,623)

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Change in Selected NOMS Outcomes by Substance Use Severity (Intake to Last Wave)

Inta

ke

Last

W

ave

Inta

ke

Last

W

ave

Inta

ke

Last

W

ave

Inta

ke

Last

W

ave0%

10%20%30%40%50%60%70%80%90%

100%No Health Prob-lems

No Mental Health Problems

No Family Prob-lems

Abstinence

No Illegal Activ-ity

Vocationally Engaged*

HousedPY Use PY Abuse

PY DependenceNo PY Use

*Past monthSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

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NOMS Outcomes: Count of Positive Outcomes (Last FU–Intake) by Substance Use Severity

No PY Use(54% w/ 1+)

PY Use(66% w/ 1+)

PY Abuse(77% w/ 1+)

PY Depen-dence

(83% w/ 1+)

0%10%20%30%40%50%60%70%80%90%

100%

6% 12%27% 36%

Less than negative one

Negative one

None

One

Two

Three

Four

Five +

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=25,162)

Chapter 8 Subset of Overview by Substance Use Severity

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