Addiction Severity Index data from general membership and treatment samples of HMO members - One case of norming the ASI

Department of Psychiatry, University of California, 401 Parnassus, Box 0984, 94143, San Francisco, CA, USA.
Journal of Substance Abuse Treatment (Impact Factor: 3.14). 10/2000; 19(2):103-9. DOI: 10.1016/S0740-5472(99)00103-8
Source: PubMed

ABSTRACT The Addiction Severity Index (ASI) is a widely used interview among substance-dependent populations in treatment. Its value as a treatment planning and evaluation tool has been diminished by the lack of comparative data from nonclinical samples. The present study included four scales from the ASI collected on samples of adult subscribers to a large health maintenance organization (HMO) in northern California, as well as an adult clinical sample from the same geographic region with the same HMO insurance, thereby offering informative contrasts. Interviews (N = 9,398) of non-alcohol-dependent or abuse adults from a random sample of members of a large HMO were analyzed. We collected complete ASI data on the alcohol, drug, medical, and psychiatric composite scales and partial data on the employment scale. A sample of 327 adult members of the same HMO from one of the counties included in the survey, who were admitted to treatment for alcohol and/or drug addiction, was administered the same ASI items at treatment admission. Analyses compare problem severities in the two samples by age and gender. The general membership reported some problems in most of the ASI problem areas, although at levels of severity that were typically far below those seen in the clinical sample. General membership and clinical samples were somewhat similar in medical status and in employment. As expected, alcohol, drug, and psychiatric status were much more severe in the clinical sample. The data from the HMO general membership sample provide one potential comparison group against which to judge the severity of problems presented by drug- and alcohol-dependent patients at treatment admission and at posttreatment follow-up. The authors discuss the implications for treatment planning and the evaluation of treatment outcome.

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    • "The collection form includes 10 items from the Addiction Severity Index [11] and the Drug Abuse Reporting Program [12]. These scales have been shown to be reliable measures of substance abuse severity [13], particularly among diverse populations [14], allowing for assessment of client reports from intake to discharge. "
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    ABSTRACT: To examine risk factors for use of hospital services among racial and ethnic minority clients in publicly funded substance abuse treatment in Los Angeles County, California. We explored cross-sectional annual data (2006 to 2009) from the Los Angeles County Participant Reporting System for adult participants (n¿=¿73,251) who received services from treatment programs (n¿=¿231). This retrospective analysis of county admission data relied on hierarchical linear negative binomial regression models to explore number of hospital visits, accounting for clients nested in programs. Client data were collected during personal interviews at admission. Our findings support previous work that noted increased use of emergency rooms among individuals suffering from mental health- and substance use-related issues and extend the knowledge base by highlighting other important features such as treatment need, i.e., residential compared to outpatient treatment. These findings have implications for health care policy in terms of the need to increase prevention services and reduce costly hospitalization for a population at significant risk of co-occurring mental and physical disorders.
    Substance Abuse Treatment Prevention and Policy 04/2014; 9(1):16. DOI:10.1186/1747-597X-9-16 · 1.16 Impact Factor
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    • "The substance abuse treatment (SAT) field in the United States faces an unprecedented challenge to reduce health disparities among racial and ethnic minority populations suffering from co-occurring substance abuse and mental health disorders [1-3]. Access to integrated care, referred here as provision of substance abuse and mental health treatment services is associated with improvement in process and health outcomes [4,5], making integration of co-occurring disorder treatment the most significant and cost-effective service delivery expansion in SAT [6,7]. However, the substance abuse and mental health treatment fields are characterized by different philosophies, approaches, and cultures that impede integration, coordination, or both of dual-diagnosis or co-occurring disorder treatment [8,9]. "
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    ABSTRACT: The high prevalence of mental health issues among clients attending substance abuse treatment (SAT) has pressured treatment providers to develop integrated substance abuse and mental health care. However, access to integrated care is limited to certain communities. Racial and ethnic minority and low-income communities may not have access to needed integrated care in large urban areas. Because the main principle of health care reform is to expand health insurance to low-income individuals to improve access to care and reduce health disparities among minorities, it is necessary to understand the extent to which integrated care is geographically accessible in minority and low-income communities. National Survey of Substance Abuse Treatment Services data from 2010 were used to examine geographic availability of facilities offering integration of mental health services in SAT programs in Los Angeles County, California. Using geographic information systems (GIS), service areas were constructed for each facility (N = 402 facilities; 104 offering integrated services) representing the surrounding area within a 10-minute drive. Spatial autocorrelation analyses were used to derive hot spots (or clusters) of census tracts with high concentrations of African American, Asian, Latino, and low-income households. Access to integrated care was reflected by the hot spot coverage of each facility, i.e., the proportion of its service area that overlapped with each type of hot spot. GIS analysis suggested that ethnic and low-income communities have limited access to facilities offering integrated care; only one fourth of SAT providers offered integrated care. Regression analysis showed facilities whose service areas overlapped more with Latino hot spots were less likely to offer integrated care, as well as a potential interaction effect between Latino and high-poverty hot spots. Despite significant pressure to enhance access to integrated services, ethnic and racial minority communities are disadvantaged in terms of proximity to this type of care. These findings can inform health care policy to increase geographic access to integrated care for the increasing number of clients with public health insurance.
    Substance Abuse Treatment Prevention and Policy 09/2013; 8(1):34. DOI:10.1186/1747-597X-8-34 · 1.16 Impact Factor
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    • "was measured using the composite scores of the Addiction Severity Index (ASI). It is a valid and reliable instrument that assesses the severity of alcohol, drug, employment, medical, psychiatric, family/social relations, and legal problems, and is one of the most commonly used in addiction treatment research (McLellan et al. 1992; McLellan et al. 1985; Weisner et al. 2000a). In each domain, questions measure the number, frequency, and duration of problem symptoms in the past 30 days, providing a continuous measure from 0 (no problems) to 1.0 (high severity). "
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    ABSTRACT: AIMS: Increased access to health care, including addiction treatment, has long been a goal of health reform in the U.S. An unanswered question is whether reform will change the way people get to addiction treatment; when treatment is easily accessible, do individuals self-refer, or do they still enter treatment via ultimatums, and if so, from which sources? To begin examining this, we used a single case study of a U.S. health plan that provides access similar to that called for in health reform. METHOD: Using a case study method of data from studies conducted in a large, private non-profit, integrated managed care health plan which includes addiction services, we examined the prevalence and source of ultimatums to enter treatment, and the characteristics of those receiving them. The plan is highly representative of changes to U.S. health care and other countries due to health reform. RESULTS: Many individuals entering addiction treatment had received an ultimatum stemming from employment, legal, medical, and family sources. Having more employment problems, an occupation with public safety concerns, being older, male, and ethnicity predicted an employment ultimatum. Higher legal problem severity predicted a legal ultimatum. More men (and younger people) had family ultimatums, and more women (and older people) had medical ultimatums. Being younger, male, married, having higher employment and family problem severity, and being drug or combined drug/alcohol dependent rather than dependent on alcohol-only predicted an ultimatum from one's family. On the whole, an ultimatum from one source was not related to having one from another source. Those most likely to receive ultimatums from multiple sources were women, those separated/divorced, and those having higher psychiatric and legal problem severity. CONCLUSIONS: Even in an insured population with good access to addiction treatment, individuals often receive ultimatums to enter treatment rather than being self-referred. Understanding the treatment entry process, and how it is affected by health care systems, could benefit from international and other comparative research.
    Nordic Studies on Alcohol and Drugs 01/2010; 27(6):685-698. · 0.61 Impact Factor
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