Chapter 20 Briefing Slides Summary 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
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Chapter 20Briefing Slides Summary
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
Briefing Book Slides: 2011 SAMHSA/CSAT Summary Analytic File This report presents information from the 2011
SAMSHA/CSAT GAIN Outcome Data set, including data on 29,782 clients from 230 local evaluations recruited between 1997 and 2011.
Data was collected using the Global Appraisal of Individual Needs (GAIN) with clients admitted for substance abuse treatment.
Eighty-nine percent of clients had one or more follow-ups at 3, 6, 9, and 12 months.
The following slides summarize highlights from Chapters 2-18
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Highlights• GAIN Data Overview (Chapter 2)
– Clients are 77% adolescents and 23% adults (age range from 9 to 73; 63% between the ages of 15 and 17; average 18.3; Chapter 2, slides 4, 7) upon admittance to substance abuse treatment.
– Clients are 73% male (Chapter 2, slide 5) and 62% non-white (16% African American, 29% Hispanic, 13% multi-racial, and 4% other; Chapter 2, slide 6).
– In the past year prior to intake, 29% of clients fit abuse criteria and 48% fit criteria for dependence (Chapter 2, slide 11).
– Most clients (79%) first used substances before the age of 15 (Chapter 2, slide 13).
– Over 50% of clients were using some substance weekly at intake, with marijuana showing the highest levels of abuse and dependence (Chapter 2, slides 14, 15).
– Co-occurring issues are the norm in this group, with 65% of clients presenting with moderate to high levels of lifetime victimization (Chapter 2, slide 25), 62% with a co-occurring mental health issue (Chapter 2, slide 26), and 78% with any violence or illegal activity in the past year
Highlights• GAIN Data Overview (Chapter 2) - continued
– Using the GAIN, the costs of behaviors that are associated with substance use can be estimated based on cost estimates available from current research. In the past year, the average cost of health care utilization across clients was $10,099, with 10% of clients in the highest cost category representing 75% of the total health care utilization costs across clients (Chapter 2, slides 32, 34).
– The average cost of criminal activity in the past year was $276,153, with the 20% of clients in the highest cost category representing 97% of the total cost of crime across all clients (Chapter 2, slides 38, 40).
– The average overall cost to society was $19,989 in the past year, with 13% of clients in the highest cost category representing 49% of the total costs to society across all clients (Chapter 2, slides 53, 55).
– Overall, there was a 19% increase in past month abstinence at 6 months post-intake (Chapter 2, slide 70).
– Eighty-five percent of clients reach initiation within 14 days of assessment, and 78% of clients were engaged for at least six weeks (Chapter 2, slide 76).
– Age does not have a consistent relationship with clinical problems at intake.– While substance abuse and dependence are slightly lower for adults age 26+
than adolescents age 15-17 (61% vs. 81%; Chapter 5, slide 8) at intake, they do use more severe substances than adolescents (higher levels of cocaine (24% vs. 3%), opioid (16% vs. 2%), and amphetamine (16% vs. 5%) use (Chapter 2, slide 9)).
– Adults (age 18+), had lower levels of criminal behavior (23% with moderate/high crime) than other age groups (49% to 65% with moderate/high crime; Chapter 5, slide 20).
– Outcomes for age showed that there is a smaller change in abstinence from intake to 6 months for adults age 18+ (15%) than for 15-17 year olds (20%) or those under 15 (25%; Chapter 5, slide 40), but adults age 26+ also have higher overall levels of abstinence at all time periods (as high as 87% at three months; Chapter 5, slide 42).
– Females have more clinical problems than males at intake (56% vs. 43% with five or more clinical problems; Chapter 6, slide 24)
– Specifically, females have more problems with severity of victimization (56% vs. 42% with high severity; Chapter 6, slide 15), mental health disorders (74% vs. 59% with one or more disorders; Chapter 6, slide 16), and physical health problems (55% vs. 42% with moderate/high problems; Chapter 6, slide 18).
– Males and females exhibit similar levels of violence and crime (36% vs. 32% with high crime; Chapter 6, slide 20), but males commit more violent crimes than females (41% vs. 30%; Chapter 6, slide 21).
– Outcomes for both genders are very similar; females had a slightly higher change in 6 month abstinence (23% vs. 18%; Chapter 6, slide 40).
– African Americans have the fewest clinical problems at intake (32% with five or more) and multi-racial clients have most (55% with five or more; Chapter 7, slide 24).
– Average Quarterly Cost to Society was very similar for all race groups (Chapter 7, slide 32); however health care costs were highest for Caucasians and multi-racial clients ($3,074 and $3,402 respectively) and lowest for Hispanics ($1,800; Chapter 7, slide 19). Cost of crime was highest for Hispanics ($852,574) and lowest for Caucasians ($250,470; Chapter 7, slide 22).
– No single group had the best outcomes overall; African Americans show the largest increase in 6 month abstinence (23%; Chapter 7, slide 40), but Hispanics met the most NOMS outcomes overall (78% with one or more and 30% with five or more; Chapter 7, slide 48).
Highlights• Characteristics by Substance Use Severity (Chapter 8)
– Clients with substance dependence in the past year have the highest levels of victimization (76% moderate/high severity; Chapter 8, slide 15), mental health disorders (81% with one or more disorders; Chapter 8, slide 16), and crime and violence (50% with high levels of crime; Chapter 8, slide 20) at intake.
– Dependent clients have the highest mean cost across all categories ($3,475 in health care utilization, $803,317 cost of crime, and $6,149 overall quarterly cost to society; Chapter 8, slides 19, 22, 32).
– Those with dependence also reach the highest level of NOMs outcome met at their last follow-up wave (83% with one or more; Chapter 8, slide 48).
• Characteristics by Risk of Homelessness (Chapter 9) – Homelessness and risk of homelessness are associated with more clinical problems,
including substance dependence (>60%; Chapter 9, slide 8), victimization (> 60% with high severity; Chapter 9, slide 15), co-occurring mental health disorders (>73% with one or more disorders; Chapter 9, slide 16), and physical health problems (>10% with high problems; Chapter 9, slide 18).
– Those who are currently homeless have the highest health care utilization costs ($4,618; Chapter 9, slide 19), and those at risk of homelessness have the highest cost of crime ($887,244; Chapter 9, slide 22).
– Currently homeless individuals reach the highest levels of NOMS outcomes met (86% with one or more; Chapter 9, slide 48).
Highlights• Characteristics by Severity of Victimization (Chapter 10)
– High victimization is associated with more substance dependence (60%; Chapter 10, slide 9), co-occurring mental health disorders (80% with one or more disorders; Chapter 10, slide 16), and crime and violence (50% with high crime; Chapter 10, slide 20).
– High victimization is also associated with higher costs across domains (cost of health care utilization, $3,483, cost of crime $977,567, overall quarterly cost to society $6,435; Chapter 10, slides 19, 22, 32).
– Those with high victimization have a smaller change in 6 month abstinence (17%) than those with moderate victimization (21%) or low victimization (22%; Chapter 10, slide 40), but meet approximately the same number of NOMS outcomes by last follow-up (80%, 78%, and 73% with one or more outcomes met respectively; Chapter 10, slide 48).
Highlights• Characteristics by Mental Health Disorders (Chapter 11)
– Those with externalizing mental health disorders are more likely to be adolescent (91%) and male (83%), while those with internalizing mental health disorders have a higher rate of adult (45%) and female (42%) clients than other groups (Chapter 11, slides 5, 6).
– Externalizing disorders are associated with higher levels of crime and violence (46% high crime) than internalizing disorders (21% high crime; Chapter 11, slide 20).
– Quarterly Costs to Society increase from externalizing disorders ($4,051), internalizing disorders ($5,607), to both ($7,181; Chapter 11, slide 32).
– Outcomes are slightly better for those with externalizing than internalizing disorders; they show a larger change in abstinence at 6 months (21% vs. 18% respectively; Chapter 11, slide 40).
Highlights• Characteristics by Physical Health (Chapter 12)
– Those with high levels of physical health problems are more likely to be female (43%) and adult (32%) than those with less severe health problems (Chapter 12, slides 5, 6).
– Those with high physical health problems also have more substance dependence (61%; Chapter 12, slide 9), higher levels of victimization (62% with high severity; Chapter 12, slide 16), and more co-occurring mental health disorders (80% with one or more disorders; Chapter 12, slide 17) than those with lower levels of health problems.
– As expected, cost of health care utilization is higher for those with high levels of health problems ($5,726) than those with moderate ($2,975) or low problems ($1,680; Chapter 12, slide 19).
– Health problems do not appear to be associated with abstinence, but those with more health problems have a higher number of NOMS outcomes met at their last wave (86% with one or more outcomes met; Chapter 12, slide 48).
Highlights• Characteristics by Crime and Violence (Chapter 13)
– Those with high levels of crime are more likely to be adolescents (87%; Chapter 13, slide 5), have more dependence (67%; Chapter 13, slide 9), higher victimization (65% with high severity; Chapter 13, slide 16), and more mental health problems (86% with one or more disorders; Chapter 13, slide 17).
– As expected, those with high levels of crime and violence have the highest cost of crime ($1,465,582; Chapter 13, slide 22), as well as higher health care ($3,447; Chapter 13, slide 20), and quarterly costs ($6,509; Chapter 13, slide 32).
– Those with higher levels of crime also have more NOMS outcomes met at their last wave (82% with one or more and 36% with five or more outcomes met; Chapter 13, slide 48).
• Characteristics by Intensity of Justice System Involvement (Chapter 14)– Intensity of justice involvement does not have a consistent relationship with many
characteristics. Those in jail 30+ days of the past 90 have lower substance use problems (68% with abuse or dependence; Chapter 14, slide 9); this is expected due to their time spent in a controlled environment before intake.
– Those in jail 30+ days of the past 90 also show a decrease in abstinence at follow-up (-10%); they have more opportunities to use after leaving jail (Chapter 14, slide 40).
Highlights• Characteristics by Grant Program (Chapter 15)
– The grant programs with the largest number of clinical problems were the Adolescent Treatment Model (ATM; 65% with five or more problems), Adolescent Residential Treatment (ART; 67% with five or more problems), and the Cannabis Youth Treatment (CYT; 53% with five or more problems; Chapter 15, slide 25) studies.
– The Adult Treatment Drug Court (ATDC) programs are unique in that they are the most Caucasian (62%; Chapter 15, slide 7), most female (62%; Chapter 15, slide 6), and have some of the most severe substance use problems (66% with past year dependence; Chapter 15, slide 9) at intake of all programs. They also seem to produce some of the most positive outcomes, including a 38% increase in abstinence from intake to 6 months (Chapter 15, slide 40)and among the highest number of NOMS outcomes met at last follow-up (81% with one or more; Chapter 15, slide 50).
Highlights• Characteristics by Level of Care (Chapter 16)
– As the number of clinical problems at intake increases, level of care becomes more intense (from outpatient services to short term residential treatment; Chapter 16, slide 25).
– Those entering residential treatment and continuing care have the highest cost to society before entering treatment (from $7,389 to $8,284 in the past 90 days; Chapter 16, slide 33).
– Medium to long term residential programs produce a larger percent change in abstinence from intake to 6 months (30%; Chapter 16, slide 40) than other levels, and both short and long term residential programs meet a large number of NOMS outcomes at last wave (87% and 85% with one or more respectively; Chapter 16, slide 48).
• Characteristics by Treatment Type (Chapter 17) – Those receiving local manualized treatments present with the largest number of
clinical problems (Chapter 17, slide 25). – Evidence based treatments result in the greatest change in abstinence from intake to
6 months (24%, Chapter 17, slide 40). – Those receiving evidence based treatments are more likely to reach initiation,
engagement, and receive continuing care (more than 55% with all 3 for A-CRA/ACC treatments; Chapter 17, slide 45).
Highlights• Unmet Need and Health Disparities (Chapter 18)
– More than 50% of clients report unmet need at 3 months for ASAM Dimensions B1 (Intoxication/Withdrawal; Chapter 18, slide 52), B2 (Physical Health; Chapter 18, slide 53), B3 (Mental Health; Chapter 18, slide 55) and B6 (Recovery Environment; Chapter 18, slide 61).
– Significant disparities in unmet need by race are evident in 6 of 7 domains.• Caucasians have lower unmet need for substance treatment (24%; Chapter 18,
slide 51). • Hispanics have higher unmet need for physical health treatment (63%; Chapter
18, slide 54). • Hispanics and African Americans have higher unmet need for mental health
treatment (84% and 80% respectively; Chapter 18, slide 56). • African Americans also have the most unmet treatment readiness need (i.e.,
24% are not engaged at 3 months; Chapter 18, slide 58). • Unmet need for monitoring of relapse potential using urine or breathalyzer
testing is highest for those classified as Other (32%; Chapter 18, slide 60). • Unmet recovery environment need (i.e., no self-help attendance) is higher for
African Americans and Hispanics (78% and 83% respectively; Chapter 18, slide 62).
2. All Data Overview 2.1. Risk and Protective Factors
2.1.1. Age 2.1.2. Gender2.1.3. Race2.1.4. Environment*2.1.5. Risk of Homelessness2.1.6. Substance Problem Recognition*2.1.7. Substance Use Severity2.1.8. Primary Substance
2.1.9. Substance Use Problems2.1.10. Pattern of Weekly Use*2.1.11. SUDs in Past Year by Major Substances*2.1.12. Tobacco Diagnosis2.1.13. Recovery Environment* 2.1.14. HIV Risk Scale2.1.15. HIV Risk Change Index2.1.16. Sex Partners2.1.17. Severity of Victimization2.1.18. Mental Health Disorders2.1.19. Co-Occurring Psychiatric Problems*2.1.20. Homicidal/Suicidal Thoughts Scale
*Not included in breakout presentations for each breakout characteristics
Table of Contents - 22.1.21. Para-Suicidal Index*2.1.22. Family History of Physical Health Problems*2.1.23. Health Problems Scale2.1.24. System Involvement*2.1.25. Health Care Utilization2.1.26. Crime and Violence2.1.27. Justice System Involvement2.1.28. Major Clinical Problems2.1.29. GI Behavior Change Scales*2.1.30. Sources of Stress2.1.31. Treatment Readiness2.1.32. Self-Help Activities2.1.33. Individual Strengths Self-Efficacy2.1.34. General Social Support
Strengths2.1.35. Spiritual Social Support Strengths2.1.36. Potential Mentors and Environmental Strengths2.1.37. Quarterly Cost to Society2.1.38. Problem Prevalence2.1.39. Quality of Life2.1.40. General Satisfaction2.1.41. Funder*2.1.42. Program2.1.43. Level of Care2.1.44. Treatment Type
2.2. Outcomes2.2.1. Days of Substance Use*
*Not included in breakout presentations for each breakout characteristics
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Table of Contents - 32.2.2. Past Month Abstinence2.2.3. Recovery2.2.4. GPRA Outcomes2.2.5. NOMS Outcomes2.2.6. Change in Scales Over Time*
Table of Contents - 5Presentations by Non-Patient Characteristics 15. Subset of Overview by Program
15.1. Risk and Protective Factors15.2. Outcomes
16. Subset of Overview by Level of Care
16.1. Risk and Protective Factors16.2. Outcomes
17. Subset of Overview by Treatment Type
17.1. Risk and Protective Factors17.2. Outcomes
18. Other Special Topics18.1. GLBTQ Status† 18.2. GAIN Placement Cells by ASAM Dimension 18.3. ASAM Planning statements 18.4. Individual Clinical Profile 18.5. Unmet need 18.6. Summary profiles by instrument
18.6.1. GAIN Short Screener Problem Profile18.6.2. GAIN Quick Version 3 Problem Profile18.6.3. GAIN-I Problem Profile– Main Scales 18.6.4. GAIN-I Problem Profile—Subscales
breakout chapters are organized as Risk and protective factors Outcomes
– Select Risk and protective factor and Outcome slides are presented by breakouts in separate files.
– Overview data for Adolescent Treatment data and Justice Program data are presented in separate files.
– Breakouts variables are: Age Gender Race Substance Use Severity Risk of Homelessness Severity of Victimization Mental Health Disorders Health Problems Crime and Violence Intensity of Justice System
Involvement Program Level of Care Type of Treatment
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Style & Organization Guide - continued
Sorting– Breakout values and other
column graphs are shown left to right from the lowest severity level to highest.
– Data are presented with the subjectively bad level (e.g. more problems or less support) on top for column graphs and on the far right for bar graphs.
Colors– Colors are kept constant
across graphs so that each category is always the same
color (i.e. age < 15 years=red).
– Colors can suggest order. Colors used are on a continuum
progress from subjectively bad (shades of red or pink) to subjectively good (blues and greens).
Severity groups where Low equals zero are formatted red, yellow, green.
Severity groups where Low includes values above zero are formatted red, gold, yellow.
Neutral colors matching the slide template are used when an item is not ordered by severity (e.g. race, program, funder).
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Style & Organization Guide - continued
Graphs with columns generally show different groups of people.
Graphs with bars (rows) generally show different variables across all people.
Percents are shown in data labels for at least the most important level when possible.
Cut points of severity groups are provided in the legends in parentheses.
When possible, scales are explained with a bar graph of
the individual items that comprise the scales followed by the grouped version of the scale on a secondary axis.
The number of records for each slide does vary. Core items generally have 29,782 records; optional items generally have 13,575 records.– On slides with multiple items,
the N in the source note is the average across all items, unless otherwise noted
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Document Accessibility
This document is Section 508 compliant for those with visual impairment.
Descriptions of slide content are located in the speaker’s notes section of each slide.
A stand alone Microsoft Word document containing this information can also be made available upon request.
Please contact the Analysis Team at [email protected] for assistance using this file or accessing GAIN data.
Detailed Acknowledgements• Any opinions about this data are those of the authors and do not reflect official positions of the
government or individual grantees. • Please include the following acknowledgement and disclaimer if you use these data: • This presentation was supported by analytic runs using data provided by Substance Abuse and
Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT) under Contracts 207-98-7047, 277-00-6500, 270-2003-00006 , 270-07-0191, and 270-2012-00001 using data provided by the following 230 grantees:
• The authors thank these grantees and their study clients for agreeing to share their data
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How to cite this document
GAIN Coordinating Center (2012). Briefing Book Slides on All Grantees in the 2011 SAMHSA/CSAT Summary Analytic File [Electronic Version]. Normal, IL: Chestnut Health Systems. November 2012. Retrieved from: http://www.gaincc.org/slides
Contributors and reviewers at the GCC listed alphabetically include Vinetha Belur, Megan Catlin, Michael Dennis, Barbara Estrada, Rod Funk, Rachael Hand, Pamela Ihnes, Melissa Ives, Kathryn Modisette, and Corey Smith