Using the Addiction Severity Index to Individualize Treatment and Track Outcomes in OST

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Using the Addiction Severity Index to
Individualize Treatment and Track Outcomes in OST

• Ron Jackson, M.S.W.
• Evergreen Treatment Services
• Seattle, WA

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Screening and Assessment

• Assessment initiates and guides the continuum of
  care.
• Assessment must occur throughout the treatment
  process.
• Assessment must be done with client involvement.
• Ongoing assessment is necessary, as an on-going
  evaluation of treatment.

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Old Open-Ended Assessment Tools

• Drug History
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________
• Medical History
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________

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New Improved Open-Ended Assessment Tools

• Drug History
• (drugs used, age of first use, amount frequency
  )
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________
• Medical History
• (List medical problems and hospitalizations)
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________
• _________________________________________________

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Standardized Tools

• Facilitate the collection of accurate information
  in a reliable and consistent manner.
• Provide clinicians and treatment agencies with
  increased accountability.
• Identify change and or lack of it, in order for
  clinicians to better match clients to treatment.

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Screening / Assessment / Diagnosis

• Screening tools - establish the presence or
  absence or the severity of a problem and indicate
  the need for more comprehensive evaluation
• CAGE / T-ACE
• MAST / DAST
• AUDIT
• Assessment / Placement Tools - initiate treatment
  planning and guide the continuum of care
• ASI
• ASAM PPCII
• GAIN
• Diagnostic Tools establish the presence of a
  DSM-IV SUD diagnosis
• SCID
• DIS
• CIDI-SAM

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Addiction Severity Index

• Standardized, semi structured multi-focused
  screening and assessment tool
• Designed for use primarily with adult substance
  abuse clients /patients
• Used to collect information regarding the nature
  and severity of problems substance abusers often
  have
• Clinical, Program Evaluation and Research
  Applicability

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Seven Potential Problem Areas

• Medical
• Employment
• Alcohol
• Drug
• Legal
• Family/Social
• Psychiatric

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What is Your Purpose Goal(s)
?

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Elements to Consider in Instrument Selection

• Clinical Utility
• Screening
• Assessment
• Diagnosis
• Patient Placement
• Treatment Planning
• Program Evaluation
• Measuring Outcomes
• Managing Resources
• Reports to Funding Sources
• Research
• Treatment Effectiveness

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Clinical Applications

• Guides initial assessment and admission
• Design intake summaries can be automated
• Make patient placement decisions using the
• ASAM PPCII (with additional questions and probes
  added)
• Develop individualized treatment plans based on
  patients unmet need for services in a variety of
  life domains
• Make referrals

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Program Evaluation

• Identifies types of patients problems
  presenting for treatment
• Quantifies level of problems
• Measures patients response to treatment
• Identifies agencies/workers strengths and areas
  for improvement with particular populations and
  problems
• Enables management by outcome
• Reports to funding sources

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Benefits of Using the ASI

• Reliable and valid assessment instrument
• Assists in identifying dually diagnosed clients
• Can be re-administered at different points in
  treatment
• Helps identify inconsistencies in client
  responses
• Widely used, can compare your program results
  with others
• Public domain tool

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Why use the ASI?

• NIDA Principle 3
• To be effective, treatment must address
  individuals drug use and any associated medical,
  psychological, social, vocational, and legal
  problems.
• ASI assesses all these dimensions

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Clinical use of ASI improves rapport
. . . If patients problems are accurately
assessed, they may feel heard by their
counselor potentially leading to the development
of rapport and even a stronger helping alliance.
Barber et al., 1999, 2001 Luborsky et al., 1986,
1996
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Using ASI to match services to patient problems
improves retention
. . . Patients whose problems are identified at
admission and then receive services that are
matched to those problems, stay in treatment
longer.
Carise et al., 2004 Hser et al., 1999 Kosten et
al., 1987 McLellan et al., 1999
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Implementation Considerations

• Staff buy-in and training
• Intake staff
• Counseling staff
• Medium paper or computer
• Supervision
• Fidelity to coding conventions
• Utilization in treatment planning
• Follow-up interviews? by whom how often

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Summary Data Analysis With the ASI

• Change in your client sample over time
• Gender comparisons
• Racial/ethnic group comparisons
• Legal status comparisons
• Primary problem substance comparisons
• Treatment history comparisons
• Psychiatric history comparisons

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Examples of Data Analysis Reports
Basic Demographic Information
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Examples of Data Analysis Reports
Change in Abstinence Rates Over Time
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Examples of Data Analysis Reports
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Mobile vs. Fixed Site OutcomesBaseline to 12
monthsDrug Use
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Mobile vs. Fixed Site OutcomesBaseline to 12
monthsSocial Functioning
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Agency Use of Information

• Internal Improvement
• Staff Kudos (evidence of job well done)
• Selecting clinical areas for improvement
• Selecting modalities for improvement
• Advocate results in community
• Use for fund-raising quests
• Use with Board of Directors

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S.M.A.R.T. Treatment Planning Utilizing the
ASIMaking Required Data Collection Useful
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What is included in any treatment plan?
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1. Problem Statements
2. Goal Statements
3. Objectives
4. Interventions
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1. Problem Statements are based on information
gathered during the assessment
2. Goal Statements are based on the problem
statements and reasonably achievable in the
active treatment phase
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• Van is experiencing increased tolerance for
  alcohol as evidenced by the need for more alcohol
  to become intoxicated or achieve the desired
  effect.

• Meghan is currently pregnant and requires
  assistance obtaining prenatal care.

• Toms psychiatric problems compromise his
  concentration on recovery.

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• Van will safely withdraw from alcohol, stabilize
  physically, and begin to establish a recovery
  program.

• Meghan will obtain necessary prenatal care.

• Reduce the impact of Toms psychiatric problems
  on his recovery and relapse potential.

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3. Objectives are what the client will do to meet
those goals
4. Interventions are what the staff will do to
assist the client

• Other common terms
• Action Steps
• Measurable activities
• Treatment strategies
• Benchmarks
• Tasks

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• Van will report acute withdrawal symptoms.

• Van will begin activities that involve a
  substance-free lifestyle and support his recovery
  goals.

• Meghan will visit an OB/GYN physician or nurse
  for prenatal care.

• Tom will list 3 times when psychological symptoms
  increased the likelihood of relapse.

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• Staff medical personnel will evaluate Vans need
  for medical monitoring or medications.

• Staff will call a medical service provider or
  clinic with Meghan to make an appointment for
  necessary medical services.

• Staff will review Toms list of 3 times when
  symptoms increased the likelihood of relapse and
  discuss effective ways of dealing with those
  feelings.

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1. Problem Statements (information from
assessment)
2. Goal Statements (based on Problem Statement)
3. Objectives (what the client will do)
4. Interventions (what the staff will do)
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5. Client Strengths are reflected.
6. Participants in Planning are documented.
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ASI Resources

• www.tresearch.org Treatment Research Institute
• http//adai.washington.edu/sounddatasource
  Sound Data Source at Univ. of Washington
• www.inflexxion.com/inf/info/faq_asimv.html
  ASI-MV