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


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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Available from: Enid M Hunkeler, Jan 06, 2016
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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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    • "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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    • "It is possible to use standardised instruments as scientifically approved forms in several ways: to facilitate outcome measurement in both clinical trials and clinical practice, and to facilitate complete record keeping and enhance transparency. In Sweden and the US, the ASI has also been used to create norm data for general and clinical populations to further the clinical usefulness of the instrument (Weisner, McLellan, & Hunkeler, 2000;Armelius, Nyström, Eng ström, & Brännström, 2009). In Sweden as well as internationally, the ASI is one of the most widely used standardised instruments in the addiction field (McLellan, Cacciola, Alterman, Rikoon, & Carise, 2006;Sundell, Brännström, Lars son, & Marklund, 2008). "
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    ABSTRACT: AIM - This article explores the implementation and use of the Addiction Severity Index in addiction treatment practice, both as a clinical instrument and as a way of facilitating outcome measurement. This is regarded as incorporating "laboratory logic" into clinical practice characterised by "the logic of care". DATA - The data is based on ethnographic fieldwork in a Swedish metropolitan social service agency known for its systematic ASI work. RESULTS - The findings suggest that much effort must be dedicated to co-ordinate activities in the agency in line with the laboratory logic, making sure that the interviews are administered systematically. In use, the ASI and the variables in clinical practice are adjusted to each other, making it possible to follow both logics at the same time. In some cases, however, there is a conflict: the ASI becomes an extra task that does not further the clinical work. Once collected, the ASI data must be co-ordinated in line with other information. This has not yet been realised in the agency, which makes the value of the ASI data unknown. CONCLUSIONS - It requires hard work to handle the two logics simultaneously in addiction treatment practice: activities must be co-ordinated, and instruments and variables in clinical practice must be continuously "tinkered" with. Further, outcome measurement is not only about systematic use of standardised instruments, but much work must be done after the ASI data has been collected.
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