Severity Index Composite Scores Research Articles

Secondary outcomes: Group and individual change and relationships to drinking outcomes

This article describes pre to posttreatment changes in secondary outcome domains, and examines the relationships between drinking outcomes and secondary outcomes, in a Swedish treatment sample. Structured interviews, including the Addiction Severity Index (ASI) Composite Scores, were performed on admission (n = 244), and after 12 months (n = 188, 77%). Significant problem reductions were observed for all domains except for the employment and medical domains. Posttreatment abstainers did not show greater improvement in secondary domains than did those who were in remission, and correlations between primary and secondary ASI domains, were generally low at baseline and follow-up. At the same time, those who met criteria for alcohol dependence during the follow-up year, reported significantly poorer secondary outcomes than did those with favorable drinking outcomes. Findings suggest that in the study sample, continuous abstinence did not automatically lead to better psychosocial adjustment, but that continued alcohol dependent drinking was associated with deterioration in secondary outcome domains.

Emergency Department Utilization by Crack-Cocaine Smokers in Dayton, Ohio

The objective of this study was to determine the frequency, principal diagnoses, and correlates of emergency department (ED) visits made by persons with a history of crack-cocaine use (n = 333) over a 3-year period. Data were collected from participant self-reports and hospital records. During the study a total of 643 ED visits were made by 211 people, ranging from 53.5 to 76.7/100 persons/year. Injury and poisoning accounted for the largest single category of ED visits (29.5%). Men had lower odds of visiting the ED (OR = 0.79, 95%CI = 0.62–0.99), as did participants with higher levels of education (OR = 0.83, 95%CI = 0.73–0.94). Number of times in drug abuse treatment (OR = 1.04, 95%CI = 1.01–1.09), having a chronic disease (OR = 1.46, 95%CI = 1.06–1.99), and higher Addiction Severity Index composite medical scores (OR = 1.62, 95%CI = 1.15–2.29) increased the odds of an ED visit. Factors in addition to drug use are likely to affect ED utilization rates among crack-cocaine smokers.

Three problems with the ASI composite scores

This article discusses three problems relating to the use and interpretation of the Addiction Severity Index (ASI) composite scores. First, the lack of standardized scores makes it difficult both to interpret and compare individual scores. Second, it is difficult to interpret a change in a composite score and to know whether this is a large or a small change. Finally, one might question the objective validity of some of the composite scores because some of the questions that go into the calculation of the composite scores invite subjective responses. Moreover, the argument that the validity of the ASI composite scores is assured by high Cronbach's alphas is rejected as largely irrelevant.

Effects of Losing SSI Benefits on Standard Drug and Alcohol Outcome Measures

P.L. 104–121 eliminated drug addiction and alcoholism (DA&A) as an impairment category for Supplemental Security Income (SSI), allowing a six-month period for DA&A recipients to request an eligibility redetermination, and terminating all SSI DA&A benefits on January 1, 1997, In a multi-site cohort study of persons affected by this change, participants were interviewed prior to the benefits termination date and reinterviewed over a two-year follow-up period. We assessed the impact of loss of SSI DA&A benefits on Addiction Severity Index (ASI) composite scores, which are often used to reflect treatment outcomes in seven areas (psychological, social, alcohol, drug, legal, employment, and medical). We classified participants as either on SSI or off SSI (n=1,670) during follow-up and analyzed ASI composite scores treating time as a linear effect, including baseline composite scores as covariates. The dependent variable in each analysis was the ASI composite score, dichotomized into high and low categories. We hypothesized that those who lost SSI benefits would experience poorer outcomes than those who requalified for benefits. In the context of the limitations discussed, the results do not support this hypothesis. Participants in both groups showed either improvement or no change over time, and patterns of change did not differ by SSI status.

Integrating Medical and Substance Abuse Treatment for Addicts Living with HIV/AIDS: Evidence‐Based Nursing Practice Model

Forty‐five active substance abusers with HIV/AIDS voluntarily participated in a substance abuse treatment research study with interviews at intake, 6 months and 12 months. These participants were engaged in treatment for a minimum of 45 days and a maximum of 90 days. The study used a nursing model of care, The Personalized Nursing LIGHT model, to integrate treatment for HIV/AIDS with substance abuse treatment. The LIGHT model seeks to enhance patient well being directly and thereby to support interventions that decrease substance use and improve management of chronic disease. The substance abuse treatment team included a nurse who used the LIGHT model and coordinated an integrated care protocol. The nurse accompanied clients on visits to their physicians for HIV treatment and facilitated the integration of medical recommendations with the substance abuse treatment. Six‐month posttest data were gathered on all 45 participants and 12‐month posttest interviews were accomplished with 29 of them. At 6 months, 78% of the respondents (35/45) reported no drug use in the past 30 days, and, at 12 months, 79% (23/29) were drug free for the past month. Significant decreases from intake to 6 months were detected on Addiction Severity Index (ASI) composite scores for drug use (p < 0.01), alcohol use (p < 0.04), medical severity (p < 0.02), psychiatric severity (p < 0.01), legal problems (p < 0.04), and employment difficulty (p < 0.01). Improvement of 6‐month drug use composite scores was related significantly to treatment duration (R = 0.42; p < 0.01). Significant decreases in ASI measures of drug use (p < 0.01), alcohol use (p < 0.01), employment difficulty (p < 0.01), and family/social problems (p < 0.01) also occurred at 12 months. Well being, as measured by a Global Well Being Index, was found to improve significantly at 6 months (p < 0.02) and 12 months (p < 0.07). Concurrently, significant improvement was observed on Medical Outcomes Study‐36‐Item Short‐Form Health Survey (SF‐36) measures of general health and health functioning. These changes were noted at 6 months in the general health (p < 0.02), mental health (p < 0.01), social functioning (p < 0.01), role/emotional status (p < 0.04), and vitality (p < 0.01) subscales. At 12 months, the social functioning (p < 0.01) subscale responses were further decreased.

"Predictive validity of the Addiction Severity Index's composite scores in the assessment of 2-year outcomes in a methadone maintenance population": Erratum.

"Predictive validity of the Addiction Severity Index's composite scores in the assessment of 2-year outcomes in a methadone maintenance population": Erratum.

Interaction Effects of Treatment Setting and Client Characteristics on Retention and Completion

Client-treatment matching assumes treatment outcome will be improved if characteristics of clients are matched to specific elements of treatment. Few empirical studies, however, have examined matching across different types of treatment settings. The present research examined differences in demographics and substance-related problems in populations admitted to three substance abuse treatment settings—outpatient (n = 1132), intensive outpatient (n = 1190), and residential (n = 149)—and tested whether interactions between client characteristics and type of setting predicted rates of 30-day retention and treatment completion. In addition, three specific hypotheses based on prior theoretical and empirical investigations were tested. Client characteristics included demographic information (e.g ., sex, age, race) and Addiction Severity Index (ASI) composite scores. Client-setting interactions were found for both retention and completion. All three hypotheses received at least partial support. Implications for client assignment and future research are discussed.

"Predictive validity of the Addiction Severity Index's composite scores in the assessment of 2-year outcomes in a methadone maintenance population": Erratum.

"Predictive validity of the Addiction Severity Index's composite scores in the assessment of 2-year outcomes in a methadone maintenance population": Erratum.

Predictive validity of the Addiction Severity Index's composite scores in the assessment of 2-year outcomes in a methadone maintenance population.

The current research tested the predictive validity of 6 of the 7 Composite Scores (CSs) of the Addiction Severity Index (ASI) in 310 methadone maintenance patients assessed at treatment entry using the ASI and other measures, and followed for 2 years. Logistic regression was used to estimate the sensitivity and specificity of the CSs at intake in predicting their respective validity criterion measures at follow up. Except for the Medical CS, each of the other 5 CS measures significantly predicted its validity criterion measure. The CSs measuring drug use, alcohol abuse, psychopathology, and legal problems had high specificity (88% [corrected] for the Drug CS, 91% for the Alcohol CS, 96% for the Legal CS, and 100% for the Psychological CS). The CSs measuring employment problems had high sensitivity (76%). The results support the predictive validity of most of the ASI CSs as measures of specific problems as well as the validity of the multidimensional construct on which the ASI is based.

Predictive validity of the Addiction Severity Index's composite scores in the assessment of 2-year outcomes in a methadone maintenance population.

Predictive validity of the Addiction Severity Index's composite scores in the assessment of 2-year outcomes in a methadone maintenance population.