Global Appraisal Of Individual Needs Research Articles

Under treatment of pain: a prescription for opioid misuse among the elderly?

To examine the demographic, physical, and mental health characteristics; current drug use patterns; motivations for use; and diversion sources among elderly prescription opioid misusers. Mixed methods design. Research field offices, or senior or community center offices in South Florida. Individuals aged 60 and over reporting past 90-day prescription medication misuse; only prescription opioid misusers (N = 88) were included in the final analysis. The Global Appraisal of Individual Needs was the main survey instrument. A subsample of elderly reporting substantial prescription drug misuse were chosen for the in-depth interview (N = 30). The mean age was 63.3. Fifty percent reported ever being admitted to a drug treatment program; several endorsed recent illicit drug use: powder cocaine and/or crack (35.2%), marijuana (30.7%), heroin (14.8%). The majority reported past year severe physical pain and discomfort (86.4%), and misuse of their primary opioid for pain (80.7%); over half (52.3%) obtained their primary opioid from their regular doctor. Qualitative data highlight the misuse of prescription opioids due to untreated or undertreated pain. Participants with primary opioid misuse for pain had over 12 times higher odds of obtaining the medication from their regular doctor (odds ratio [OR] = 12.22, P = 0.002) and had lower odds of using a dealer (OR = 0.20, P = 0.005). Findings suggest that this group of elderly participants often misuse their own prescriptions for pain management. This study highlights the need to educate prescribing professionals on appropriate pain management for older adults while still being sensitive to issues of substance abuse and dependence.

A psychometric assessment of the GAIN Individual Severity Scale (GAIN-GISS) and Short Screeners (GAIN-SS) among adolescents in outpatient treatment programs

The Global Appraisal of Individual Needs (GAIN) - General Individual Severity Scale (GAIN-GISS), and GAIN-Short Screener (GAIN-SS) are widely used diagnostic measures of internalizing disorders, externalizing disorders, substance abuse, and criminal and violent behavior. Although prevalent in clinical and research settings, there is only limited psychometric evidence of the dimensional structure of these scales. Our investigation used intake data from 6,909 adolescents presenting to outpatient substance abuse treatment facilities in the United States. Our analytic approach used exploratory and item factor analyses to evaluate the underlying factor structure. Multi- and unidimensional item response theory models were employed to evaluate the utility of the scales at providing precise score estimates at various locations of severity. Most scales were confirmed as unidimensional; scales with evidence of multidimensionality, identified as having a weak general dimension and strong specific dimensions using a bifactor IRT model, include the Crime and Violence Scale and the GAIN-SS.

Enhanced Case Management versus Substance Abuse Treatment Alone among Substance Abusers with Depression

Abstract This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to enhanced case management (ECM) (n = 64) or treatment as usual (TAU) (n = 56). Both groups were followed up at six and 12 months. Participants' current clinical status across a broad range of domains in the past 90 days was assessed using the Global Appraisal of Individual Needs and included their Depressive Symptom Scale, Homicidal-Suicidal Thought Index, and Mental Health Treatment Index scores. The findings did not reveal any statistically significant effects of ECM on outcome measures. However, in view of the high rates of adverse treatment outcomes among comorbid groups, including suicide, the finding of a clinically significant reduction in homicidal and suicidal thoughts warrants further research; the comprehensive approach to treatment tested may be especially helpful to depressed substance abusers with such ideations. KEY WORDS: case management; comorbidity; depression; integrated care; suicide Substance use disorders and depression often coexist; in the United States, about 15% of individuals meeting criteria for past-12-month substance use disorder also met criteria for major depressive disorder (Grant et al., 2004). Comorbid substance use with depression tends to worsen clinical course and outcomes (Bums & Teesson, 2002; Bums, Teesson, & O'Neill, 2005; Hasin et al., 2002), and those with such comorbidity are at a high risk of suicide (Davis, Uezato, Newell, & Frazier, 2008; Davis et al., 2006; Yaldizli, Kuhl, Graf, Wiesbeck, & Wurst, 2010). Appropriate interventions that have been empirically tested and that take into consideration the additional treatment needs of this population are needed. In the past 10 years, integrated treatment for comorbid groups has been advocated to avoid a fragmentary approach to care and to facilitate coordinated, comprehensive, and efficient treatment (Chi, Satre, & Weisner, 2006; Nunes & Levin, 2004; Substance Abuse and Mental Health Services Administration, 2002). A meta-analysis of integrated treatment for coexisting depression and substance use disorders (Hesse, 2009) showed that integrated psychosocial treatment targeting both conditions (as compared with single-focus treatments) was related positively to improved outcomes in temas of percentage of days abstinent, depressive symptoms, and retention in treatment. Hesse concluded that although integrated treatment seems to be promising, more trials are needed to replicate such findings. In the current study, we compared an enhanced case management (ECM) model with treatment as usual (TAU) at a substance abuse treatment facility. ECM was based on motivational interviewing, an integrated approach to address both substance abuse and comorbid depression. The focus was on providing information from standardized psychiatric assessments to the case managers to improve detection of the comorbid psychiatric disorder, to actively engage patients in depression treatment, to educate them about the relationship between the substance use and depressive symptoms, to identify and overcome barriers to care, and to increase retention in the treatment program. We hypothesized that compared with TAU participants, participants who received ECM would show increased involvement with mental health treatment services for continued management of substance use and coexisting depression, a decrease in depressive symptoms, and a decrease in homicidal or suicidal thoughts. MATERIALS AND METHOD Procedure The study was a collaborative project between Washington University School of Medicine (WUSM) and six adult treatment units (three intensive outpatient and three regular outpatient treatment units) within the facilities of the Madison County, Illinois, Chestnut Health Systems (CHS) drug abuse treatment system. …

The GAIN Short Screener (GSS) as a Predictor of Future Arrest or Incarceration among Youth Presenting to Substance Use Disorder (SUD) Treatment

The National Institutes of Health (NIH) data harmonization project on existing measures (www.phenx.org) has recommended the Global Appraisal of Individual Needs (GAIN)—Short Screener (GSS) as one of the most reliable, valid, efficient, and inexpensive general behavioral health screeners to quickly identify people with internalizing and externalizing mental health disorders, substance use disorders, and crime/violence problems. The present study examined how well the four GSS screeners and their sum predict future arrest or incarceration among individuals entering treatment for a substance use disorder. Using a cross-validation design, a diverse sample of 6,815 youth with substance use disorders was split into a development sample and a validation sample. Overall, results found the GSS’s crime and violence screener (CVScr) and the substance disorder screener (SDScr) to be the two best predictors of arrest/incarceration within the 12 months following treatment intake. Additionally, we found that these screeners could be used to categorize individuals into three groups (low risk, moderate risk, high risk) and this simplified classification had good predictive validity (Area Under the Curve = 0.601). In sum, the GSS’s predictive validity was similar to other instruments that have been developed to predict risk for recidivism; however, the GSS takes only a fraction of the time to collect (ie, approximately 2–3 minutes for just these two screeners).

Effectiveness of A-CRA/ACC in Treating Adolescents with Cannabis-Use Disorders

An evidence-based treatment for adolescent cannabis users, Adolescent Community Reinforcement Approach with Assertive Continuing Care, was implemented in a rural county and small city in the USA. A total of 147 adolescents, ages 12-18, were enrolled and assessed at baseline and three time points: 3, 6, and 12 months using the Global Appraisal of Individual Needs and related measures. Program effectiveness was confirmed. The treatment was equally effective for youth from the city versus the county. More than two-thirds (68.7%) of the adolescents reported quitting use of cannabis by 12 months. The days of cannabis use in the last 90 days decreased significantly from the first follow-up, controlling for age (p value < .01), and shows consistent decline until the end of the treatment. In addition to reduction in substance use, the average number of days missing school and expelled from school decreased significantly from baseline to the end of the treatment.

Tradução e adaptação cultural do global appraisal of individual needs - initial

The objective of this study was to perform the translation and cultural adaptation of the Global Appraisal of Individual Needs - Initial instrument, and calculate its content validity index. This is a methodological study designed for the cultural adaptation of the instrument. The instrument was translated into Portuguese in two versions that originated the synthesis of the translations, which were then submitted to the evaluation of four judges, experts in the field of alcohol and other drugs. After the suggested changes were made, the instrument was back-translated and resubmitted to the judges and authors of the original instrument, resulting in the final version of the instrument, Avaliação Global das Necessidades Individuais - Inicial. The content validity index of the instrument was 0.91, considered valid according to the literature. The instrument Avaliação Global das Necessidades Individuais - Inicial was culturally adapted to the Portuguese language spoken in Brazil; however, it was not submitted to tests with the target population, which suggests further studies should be performed to test its reliability and validity.

Mental health treatment need among pregnant and postpartum women/girls entering substance abuse treatment.

Substance use during pregnancy is widely acknowledged as a major public health concern with detrimental effects on both mother and unborn child. Mental health issues often co-occur with substance use and may trigger continued use during pregnancy or relapse to use postpartum, though little is known about the extent of these issues in pregnant and postpartum women entering substance abuse treatment. The purpose of this study is: (a) to examine self-reported mental health in a population of women and girls who were pregnant in the past year and are entering substance abuse treatment, and (b) to determine whether disparity exists in mental health treatment received across groups by race and age if a treatment need is present. Secondary data analysis was conducted with Global Appraisal of Individual Needs (GAIN) data from 502 female adolescents and adults who reported having been pregnant in the past year and who completed the GAIN upon entry into substance abuse treatment. Participants were compared on demographic, diagnostic, and problem severity variables by race and age. Results indicate that mental health treatment need is high among the whole pregnant and postpartum sample, but African American and Hispanic women and girls are receiving less mental health treatment than other groups despite having a need for it. No mental health treatment acquisition disparity was found by age.

Contribuições do instrumento “Global Appraisal of Individual Needs” para a assistência e pesquisa: revisão da literatura

Objective: To analyze the literature searching for contributions of the instrument“Global Appraisal of Individual Needs” - GAIN for treatment and research on the topic of alcoholand other drugs. Methods: integrative review on the PUBMED database. Results: the instrumenthas good levels of validity and reliability, being based on evidence, and contributes to the careand research related to the harmful use of alcohol and other drugs because it is able to identifyseveral psychosocial problems especially among adolescents and adults. The GAIN is a series ofmeasurements made in support of a progressive therapy practices, including initial assessment,brief interventions, to aid diagnosis, and other factors that will enable a practice focused on theneeds of individual.

Comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) in Predicting the Effectiveness of Drug Treatment Programs for Pregnant and Postpartum Women

This study conducts a within-subject comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) to assess change in alcohol and other drug treatment outcomes for pregnant and postpartum women. Data are from 139 women who were pregnant or who had children under 11 months old and were admitted to residential drug treatment, then re-interviewed 6 months postdischarge (83% follow-up rate). The ASI and GAIN change measures were compared on their ability to detect changes in alcohol and drug use, medical and HIV risk issues, employment issues, legal problems, family and recovery environment characteristics, and psychological/emotional issues. The measures were similar in their ability to detect treatment outcomes, and ASI and GAIN change scores were moderately correlated with each other. The GAIN scales had equal or slightly higher coefficient alpha values than the ASI composite scores. The GAIN also includes an HIV risk scale, which is particularly important for pregnant and postpartum women. These results suggest that the GAIN is comparable with the ASI and can be used for treatment research with pregnant and postpartum women.

Impact of a training and certification program on the quality of interviewer-collected self-report assessment data

The purpose of this study was to evaluate the impact of an assessment training and certification program on the quality of data collected from clients entering substance abuse treatment. Data were obtained from 15,858 adult and adolescent clients entering 122 treatment sites across the United States using the Global Appraisal of Individual Needs–Initial (GAIN-I). GAIN Administration and Fidelity Index (GAFI) scores were predicted from interviewer certification status, interviewer experience, and their interactions. We controlled for client characteristics expected to lengthen or otherwise complicate interviews. Initial bivariate analyses revealed effects for certification status and experience. A significant interaction between certification and experience indicates interviewers attaining certification and having more experience far outperformed certified interviewers with low experience. Although some client characteristics negatively impacted fidelity, interviewer certification and experience remained salient predictors of fidelity in the multivariate model. The results are discussed with regard to the importance of ongoing monitoring of interviewer skill.

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12–17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

Stress and Traumatic Stress: How Do Past Events Influence Current Traumatic Stress among Mothers Experiencing Homelessness?

The purpose of this research was to evaluate the relationship between past traumatic events and the level of current traumatic stress among mothers experiencing homelessness. The data for this study were gathered from 75 homeless mothers between May 2006 and October 2006 using a cross-sectional survey design with purposive sampling. All mothers were interviewed in a face-to-face, semistructured interview format using standardized questionnaires and measures, including the Global Appraisal of Individual Needs- Quick, Williams' Life History Calendar of Traumatic Events, the Traumatic Stress Index, and the Davidson Trauma Scale. The mothers ranged in age from 18 to 50. Forty-four percent were white, 21% were African American, 3% were Native American, 31% identified themselves as multiracial, and 9% reported Hispanic ethnicity. The analysis indicated that the average level of traumatic stress from past traumatic events and the number of distressing (but nontraumatic) events did not influence current traumatic stress; however, the number of past traumatic events significantly influenced the current level of traumatic stress among mothers experiencing homelessness. Recommendations for future research include investigating how traumatic stress affects a mother's ability to locate, find, and retain housing and how trauma interventions influence mothers to exit homelessness.

Screening for atypical suicide risk with person fit statistics among people presenting to alcohol and other drug treatment

Symptoms of internalizing disorders (depression, anxiety, somatic, trauma) are the major risk factors for suicide. Atypical suicide risk is characterized by people with few or no symptoms of internalizing disorders. Objective In persons screened at intake to alcohol or other drug (AOD) treatment, this research examined whether person fit statistics would support an atypical subtype at high risk for suicide that did not present with typical depression and other internalizing disorders. Methods Symptom profiles of the prototypical, typical, and atypical persons, as defined using fit statistics, were tested on 7408 persons entering AOD treatment using the Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003a,b). Results Of those with suicide symptoms, the findings were as expected with the atypical group being higher on suicide and lower on symptoms of internalizing disorders. In addition, the atypical group was similar or lower on substance problems, symptoms of externalizing disorders, and crime and violence. Conclusions Person fit statistics were useful in identifying persons with atypical suicide profiles and in enlightening aspects of existing theory concerning atypical suicidal ideation.

Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users.

Post-discharge monitoring and early reintervention have become standard practice when managing numerous chronic conditions. These two experiments tested the effectiveness of recovery management checkup (RMC) protocols for adult chronic substance users. RMC included quarterly monitoring; motivational interviewing to provide personalized feedback and to resolve ambivalence about substance use; treatment linkage, engagement and retention protocols to increase the amount of treatment received. Recruited from sequential addiction treatment admissions, participants in the two experiments were, on average, 36 and 38 years of age, mainly female (59% versus 46%), African American (85% versus 80%) and met past-year criteria for dependence (87% versus 76%). Participants in both experiments were assigned randomly to the RMC or control condition and interviewed quarterly for 2 years. The Global Appraisal of Individual Needs (GAIN) was the main assessment instrument. RMC participant outcomes were better than control participants in both experiments. Effect sizes were larger in the second experiment in terms of reducing days to readmission (Cohen's d = 0.41 versus d = 0.22), successive quarters in the community using substances (d = -0.32 versus -0.19), past-month symptoms of abuse/dependence (d = -0.23 versus -0.02) and increasing the days of abstinence over 2 years (d = +0.29 versus 0.04). RMC, which provided ongoing monitoring and linkage, is feasible to conduct and is effective for adults with chronic substance dependence.

Global Appraisal of Individual Needs Short Screener (GSS): Psychometric Properties and Performance as a Screening Measure in Adolescents

Psychiatric and substance use disorders, separately or combined, are frequent in adolescence. Brief, psychometrically sound screening tools are needed to identify those at-risk. The Global Appraisal of Individual Needs–Short Screener (GAIN–SS) is a brief, inexpensive screener that was derived from the well researched full GAIN interview. However, its validity has not been independently investigated based on independent validated screening instruments in an adolescent clinical population. In this project, the internal consistency, validity, and optimal screening cutoff scores were examined in 95 adolescents, most of whom were receiving treatment, and suffered from internalizing (52%; n = 49), externalizing (66%, n = 63), and co-occurring substance use disorders (55%, n = 56). Results indicated adequate internal consistency and overall and subscale construct validity. Receiver operating characteristics (ROC) analyses revealed that the GSS substance use disorder subscale had adequate sensitivity (88%) and specificity (89%). Psychiatric disorder subscales performed less well. The discussion focuses on the strengths and potential weaknesses of use of the GSS and its potential utility in other populations.

Seven-Year Life Outcomes of Adolescent Offenders in Los Angeles

We examined important life outcomes for adolescent offenders to describe how they were faring in young adulthood. We assessed 449 adolescent offenders (aged 13-17 years) in Los Angeles, CA, whose cases had been adjudicated by the Los Angeles Superior Court and who had been referred to group homes between February 1999 and May 2000. We used the Global Appraisal of Individual Needs to interview respondents at baseline and at 3, 6, 12, 72, and 87 months after baseline. A total of 395 respondents (88%) were interviewed or confirmed as dead at the final interview. At final interview, 12 respondents had died, 7 of them from gunshot wounds. Thirty-six percent of respondents reported recent hard drug use, and 27% reported 5 or more symptoms of substance dependence. Sixty-six percent reported committing an illegal activity within the previous year, 37% reported being arrested within the previous year, and 25% reported being in jail or prison every day for the previous 90 days. Fifty-eight percent had completed high school or obtained a GED, and 63% reported working at a job in the previous year. The high rates of negative life outcomes presented here suggest the need for more effective rehabilitation programs for juvenile offenders.

Development and validation of short versions of the internal mental distress and behavior complexity scales in the Global Appraisal of Individual Needs (GAIN).

Co-occurring mental distress and behavior problems are the norm in substance abuse treatment but are often poorly assessed due to resource constraints. This paper describes the development and validation of scales measuring internalizing mental distress and externalizing behavior problems that are shorter versions of comorbidity scales found in the full Global Appraisal of Individual Needs (GAIN). GAIN data from two treatment outcome studies, one involving adolescents and the other on adults, were used in the creation and testing of the scales. Subsets of items from the full GAIN scales were selected for the short scales through the application of standard psychometric principles. The short comorbidity scales still have moderate to high reliability and are highly correlated with the full scales. Parallel tests of construct validity show no substantial loss when moving from the longer to shorter versions. The short scales maintain good sensitivity and specificity for predicting diagnostic impressions.

Baseline Depressive Symptoms Predict Poor Substance Use Outcome Following Adolescent Residential Treatment

To characterize baseline depressive symptoms among substance-abusing adolescents and determine their association with post residential treatment substance use outcomes. In total, 153 adolescents (mean age 6.6 years, +/- 0.11) entering residential treatment were assessed at intake and at 3, 6, 9, and 12 months. Beck Depression Inventory (BDI) and Global Appraisal of Individual Needs were administered to assess depression, other risk factors, and substance use. A regression model was developed with 10 risk factors including BDI scores of >/=11 versus <11 to predict the outcome measure mean percentage of days in the past 90 days with any (nonnicotine) substance use. At intake, 55% had BDI scores of >/=11. A baseline BDI score of >/=11 was significantly associated with greater mean percentage of days of substance use (27.5 +/- 3.8% versus 15.4 +/- 4.0% days, p <.01) across 1-year follow-up. Two other factors were significant: length of drug career >2 years and having an opioid use disorder. Results from this prospective study, although preliminary, suggest the association of depressive symptoms with poorer substance outcomes and the utility of the BDI as a prognostic tool. They highlight the need for interventions targeting co-occurring depressive symptoms that may improve adolescent substance treatment outcomes.

Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment

As the field follows recommendations to introduce standardized assessments on substance, mental, and behavioral problems, a consistent picture has emerged that co-occurring disorders are common, that there is heterogeneity in the type of disorder, and that the pattern varies by age. This study examines the prevalence of self-reported substance use and mental health problems, the pattern of comorbidity, and how both vary by age among people presenting to substance abuse treatment. Data are from 4,930 adolescents and 1,956 adults admitted to substance abuse treatment in multisite studies who were assessed with the Global Appraisal of Individual Needs and categorized into five age groups: <15, 15–17, 18–25, 26–39, and 40+ years. Two thirds of clients had a co-occurring mental health problem in the year prior to treatment admission. Across all ages, clients self-reporting criteria for past-year substance dependence were more likely than those who did not to have other co-occurring mental health problems (odds ratios of 2.9 to 8.8). The prevalence and patterns of co-occurring mental health problems, however, varied by age. Young adults (ages 18–25) were found to be most vulnerable to co-occurring problems.