Chapter 8 Subset 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
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Chapter 8 Subset of Overview by Substance Use Severity
Chapter 8 Subset 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. - PowerPoint PPT Presentation
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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
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,358)
4
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+
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,358)
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,348)
7
Race 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%
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,344)
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,225)
9
Primary Substance 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%
99%
39%27% 21%
44% 66%
54%
Other Drug
Opioids
Amphetamines
Cocaine
Marijuana
Alcohol
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,307)
10
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,307)
11
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,998)
12
HIV Risk Scale* by Substance Use Severity
* Available at intake only.
No PY Use PY Use PY Abuse PY De-pendence
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)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,344)
13
HIV Risk Change Index* bySubstance Use Severity
No PY Use PY Use PY Abuse PY De-pendence
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.
SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,841)
14
Number of Sex Partners* 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% 4% 9% 16% 18%3+ Sex Partners
1-2 Sex Partners
No Sex Partners
*In the past 90 days
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,366)
15
Severity of Victimization 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%
27% 35% 35%58%
High Severity (4-15)
Moderate Severity (1-3)
Low Severity (0)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,103)
16
Mental Health Disorders 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%16% 13% 18%
51%
Both
Internalizing Disorders Only
Externalizing Disorders Only
Neither
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,287)
17
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,071)
18
Health Problems 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% 5% 7% 6% 11%High Prob-lems(33-100)
Moderate Problems (10-32)
Low Prob-lems(0-9)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,087)
19
Health Care Utilization Cost* 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%
$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
20
Crime & Violence 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%12% 14%
29%49%
High Crime(7-29)
Moderate Crime (3-6)
Low Crime(0-2)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,302)
21
Type of Crime 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%19% 18%
34%49%
Violent Crime*
Other Crime**
Drug Use only
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,981)
* Violent crime includes assault, rape, murder, and arson.** Other crime includes vandalism, possession of stolen goods, forgery, and theft.
22
Cost of Crime* by Substance Use Severity
*Using 2011 Dollars
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,405)
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
23
No PY Use PY Use PY Abuse PY De-pen-
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,218)
24
Count of Major Clinical Problems* at Intake 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%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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,358)
25
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,474)
26
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,978)
27
Self-Help Activities 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%
94%76%
88%
64%
Low Activ-ity (0)
Moderate Activity (1-11)
High Activ-ity (12-19)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=8,286)
28
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,646)
29
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=14,600)
30
Spiritual Social Support 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%
51% 44%57% 51%
Low Support (0-2)
Moderate Support (3-5)
High Support (6-7)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,363)
31
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,229)
Quarterly Cost to Society* by Substance Use Severity
*Using 2011 DollarsSAMHSA 2011 GAIN Summary Analytic Data Set (n=26,349)
33
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)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,582)
34
No PY Use PY Use PY Abuse PY De-pendence
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=21,882)
35
General Satisfaction 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%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)
36
Program 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%ATMARTCYTYORPORPATDCSCYAAFTDCEATTCEOther
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,358)
37
Level of Care 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%
79% 75% 79%64%
12% 14% 11%
13%
3% 8% 5%8%
6% 3% 5%13%
2%
STR
M-LTR
CC-OP
IOP
OP
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,370)
38
Type of Treatment 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%
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
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,510)
39
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
Percent Change in 6 Month Abstinence by Substance Use Severity
No PY Use PY Use PY Abuse PY De-pendence
-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)
41
Relative Percent Change in 6 Month Abstinence by Substance Use Severity
No PY Use PY Use PY Abuse PY De-pendence
-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)
42
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
43
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
45
NOMS Outcome: Number of Treatment Received Outcomes Met* 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%
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)
46
SAMHSA Outcome: Treatment Cost Bands 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%
66%49% 53% 44%
Above
Within
Below
SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=17,623)
47
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
48
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)