Are long-term alcohol health harms overlooked in individuals with illicit drug problems? Alcohol-related morbidity and mortality in a Danish cohort of clients in residential rehabilitation for drug use disorders.

AIMS: This study described the burden of alcohol-related morbidity and mortality among those who had been enrolled in residential treatment for drug use disorders in Denmark and investigated whether self-reported information on alcohol use provided at treatment admission can be used to assess risk for future serious alcohol-related harms. METHODS: At baseline (entry in drug use disorder treatment during 2000-10), clients completed a European adaptation of the Addiction Severity Index-5. We tracked 4981 clients through 2018 using multiple national registers to identify fully (100%) alcohol-attributable hospital contacts and deaths. RESULTS: The death rate due to fully alcohol-attributable causes was 411 per 100 000 person-years, with an average of 0.18 fully alcohol-attributable hospital contacts per person-year. Using the Addiction Severity Index-5 alcohol composite score as a predictor in an adjusted competing risks regression model, a higher score was associated with a higher risk of alcohol-related death. The alcohol composite score was a significant predictor of alcohol-related hospital contacts in an adjusted recurrent events model. CONCLUSIONS: A substantial proportion of people originally identified as experiencing drug use disorders have alcohol problems that need to be monitored and managed to prevent serious complications. By demonstrating the predictive power of self-reported data, our study concludes that the Addiction Severity Index-5 can be used to identify individuals with drug use disorders at risk for severe long-term alcohol-related health outcomes.

Addiction severity and re-employment in Sweden among adults with risky alcohol and drug use.

BACKGROUND: The Addiction Severity Index (ASI) assesses respondents' biopsychosocial problems in seven addiction-related domains (mental health, family and social relations, employment, alcohol use, drug use, physical health, and legal problems). This study examined the association between the seven ASI composite scores and re-employment in a sample of Swedish adults screened for risky alcohol and drug use who were without employment at assessment. METHODS: We conducted a retrospective cohort analysis of employment outcomes among 6502 unemployed adults living in Sweden who completed an ASI assessment for risky alcohol and drug use. The study linked ASI scores to annual tax register data. The primary outcome was employment, defined as having earnings above an administrative threshold. We used Cox proportional hazard models to estimate the association between time to re-employment and ASI composite scores, controlling for demographic characteristics, RESULTS: Approximately three in ten individuals in the sample regained employment within five years. ASI composite scores suggested widespread biopsychosocial problems. Re-employment was associated with lower ASI composite scores for mental health (estimate: 0.775, 95 % confidence interval: 0.629-0.956), employment (estimate: 0.669, confidence interval: 0.532-0.841), drug use (estimate: 0.628, confidence interval: 0.428-0.924), and health (estimate: 0.798, confidence interval: 0.699-0.912). CONCLUSIONS: This study suggests that several ASI domains may provide information on the complex factors (i.e., mental health, health, drug use) associated with long-term unemployment for people with risky substance use.

Recent and lifetime maternal substance use: Rurality and economic distress.

Research on opioid use disorder (OUD) in pregnancy has mainly considered women in urban areas receiving treatment, with less known about women in rural areas. We sought to describe demographics and substance use characteristics of pregnant women with OUD and to compare the women based on urbanicity, in a state (Kentucky) with unfavorable economic conditions in many rural counties; we hypothesized that pregnant women in rural areas would have greater adversity, broadly defined, related to substance use. Using data collected from a larger project between 2017 and 2020, we analyzed characteristics of 93 pregnant women (59 rural and 34 urban) with OUD; we examined data in medical, employment, substance use, legal, family history, relationship, and psychiatric health domains, both overall and within rural (population <50,000) and urban (population ≥50,000) strata. Pregnant women with OUD from rural and urban areas were similar on almost all attributes. Among the few significant differences, 30% from urban areas perceived inadequate prenatal care versus 11% from rural areas (p = 0.024); 21% of urban women used amphetamines/methamphetamines in the month before delivery versus 0% of rural women (p < 0.001); and rural women had longer most recent abstinence from substance use than their urban counterparts (medians 7.0 and 2.8 months, p = 0.049). The few significant differences that were discovered favored rural women. These findings, contrary to our hypothesis, suggest that tailoring interventions may require more than focusing on geography. The participants in this study were pregnant women being treated for OUD, and as such there is patient contribution of data.

Compulsory care of individuals with severe substance use disorders and alcohol- and drug-related mortality: A Swedish registry study.

Aim: This study used 17 year of Swedish registry data (2003-2019) for 25,125 adults assessed for their severity of substance use to identify the baseline factors predicting the risk of being court-ordered into compulsory care and examine the association between admission to compulsory care and mortality risks due to alcohol- or drug-related causes. Methods and materials: Addiction Severity Index (ASI) assessment data were linked to register data on demographic characteristics, compulsory care, and alcohol- and drug-related mortality. Cox regression models were used to identify baseline factors predictive of post-assessment admission to compulsory care in the 5 years post-substance use assessment. Discrete-time random-effect logistic regression models were used to examine the association between compulsory care duration and alcohol or drug-related mortality risks. Propensity score matching was used for validation. Results: The first models identified that younger age, female gender, and ASI composite scores for drug use, mental health and employment were significantly associated with the risk of placement in compulsory care for drugs other than alcohol. Female gender and ASI composite scores for alcohol, drug use and employment were significantly associated with compulsory care treatment for alcohol use. The second models showed that older individuals and men were more likely to die due to alcohol-related causes, while younger individuals and men were more likely to die due to drug-related causes. Length of stay in compulsory care institutions significantly increased the likelihood of dying due to substance use-related causes. Propensity scores analyses confirmed the results. Conclusion: In Sweden, a significant concern is the higher likelihood of women and young individuals to be court-ordered to compulsory care. Although compulsory care is often advocated as a life-saving intervention, our findings do not provide strong support for this claim. On the contrary, our findings show that admission to compulsory care is associated with a higher risk of substance use-related mortality. Factors such as compulsory care often not including any medical or psychological therapy, together with relapse and overdose after discharge, may be possible contributing factors to these findings.

Psychiatric Treatment and Repeat Suicide Attempts Among Adults With Substance Use, by HIV Status, United States, 2014-2020.

OBJECTIVES: The association among psychiatric treatment history, HIV, and suicide reattempts among people starting treatment for substance use is not well understood. The objective of this study was to describe, by HIV status, the risk and protective factors associated with suicide reattempts among adults seeking treatment for substance use. METHODS: The study included 340 390 US adult residents aged ≥18 years in the Addiction Severity Index-Multimedia Version network from January 1, 2014, through December 31, 2020. We used adjusted logistic regression models to estimate strength of association between prior psychiatric treatment, HIV status, and sociodemographic factors and suicide reattempts within 30 days of treatment evaluation. RESULTS: Adults who had been prescribed psychiatric medication were less likely to have a recent suicide reattempt (adjusted odds ratio [aOR] = 0.8; 95% CI, 0.7-0.8) than adults with no prescription history. Adjusted models found similar protective effects between psychiatric treatment and suicide reattempts among adults reporting abuse, mental illness, injection drug use, and limited activity because of a medical condition. Conversely, the following were associated with recent suicide reattempts: being male (aOR = 1.4; 95% CI, 1.3-1.5), having a high school education/GED (General Educational Development) or less (aOR = 1.2; 95% CI, 1.1-1.2), being single (aOR = 1.2; 95% CI, 1.1-1.3), experiencing a pain problem (aOR = 1.2; 95% CI, 1.2-1.3), and not being referred to substance use treatment by court (aOR = 3.4; 95% CI, 3.2-3.7). CONCLUSIONS: A history of prescribed psychiatric medication is significantly associated with a reduced risk for suicide reattempts among adults seeking substance use treatment. Clinicians should consider incorporating mental health and suicide assessments into substance use treatment plans.

Alcohol as a risk factor for mortality in liver transplant patients in Sweden.

OBJECTIVES: Liver transplantation (LT) is the only available cure for end-stage liver disease and one of the best treatment options for hepatocellular carcinomas (HCC). Patients with known alcohol-associated cirrhosis (AC) are routinely assessed for alcohol dependence or abuse before LT. Patients with other liver diseases than AC may consume alcohol both before and after LT. The aim of this study was to assess the effects of alcohol drinking before and after LT on patient and graft survival regardless of the etiology of liver disease. MATERIALS AND METHODS: Between April 2012 and December 2015, 200 LT-recipients were interviewed using the Lifetime Drinking History and the Addiction Severity Index questionnaire. Patients were categorized as having AC, n = 24, HCC and/or hepatitis C cirrhosis (HCV), n = 69 or other liver diseases, n = 107. Patients were monitored and interviewed by transplantation-independent staff for two years after LT with questions regarding their alcohol consumption. Patient and graft survival data were retrieved in October 2019. RESULTS: Patients with AC had an increased hazard ratio (HR) for death after LT (crude HR: 4.05, 95% CI: 1.07-15.33, p = 0.04) and for graft loss adjusted for age and gender (adjusted HR: 3.24, 95% CI 1.08-9.77, p = 0.04) compared to the other patients in the cohort. There was no significant effect of the volume of alcohol consumed before or after LT on graft loss or overall survival. CONCLUSION: Patients transplanted for AC have a worse prognosis, but we found no correlation between alcohol consumed before or after LT and graft or patient survival.

Comparing the Addiction Severity Index (ASI) and Measurements in the Addictions for Triage and Evaluation (MATE).

Substance use disorder (SUD) assessment and measurement in Brazil, as well as in many other countries, face significant shortcomings. The Measurement in the Addictions for Triage and Evaluation (MATE) was developed as a public domain tool, drawing from validated scales and incorporating World Health Organization International Classification of Functioning, Disability, and Health (ICF) framework. The Brazilian version of the MATE (MATE-pt-BR) was evaluated for its reliability and validity, with a total of 239 subjects participating in the study, and data collected between 11/01/2021 and 09/01/2022. The majority were male (79.2%), with diverse racial backgrounds. The substances most prevalently used in the last 30 days were. Alcohol (73.2%), nicotine (63.6%), and cocaine (44.2%). The mean scores for MATE modules showed variations, with Module Q2 assessing psychological well-being having high internal consistency (Cronbach's alpha = 0.92). MATE-pt-BR demonstrated robust internal consistency, with Module 6 (personality) and Module 2 (medical and psychiatric consultation indicators) being exceptions. MATE-pt-BR exhibited significant correlations among its sections and strong discriminant validity. Moreover, the paper compares MATE-pt-BR with the Addiction Severity Index (ASI-6), which is considered the gold-standard measure for SUD assessments. MATE-pt-BR offers a valuable tool for assessing substance use and related functional impairments in the Brazilian context.

Multidimensional evaluation of a 12-month intensive outpatient program for the treatment of substance use disorder. Experience in Argentina / Evaluación multidimensional de un programa de tratamiento ambulatorio intensivo de 12 meses para el trastorno por uso de sustancias. Experiencia en Argentina.

OBJECTIVE: The purpose of this study was to asess the efficacy of an intensive outpatient treatment (IOT) for substance use disorder (SUD) using a multidimensional approach. METHODS: All the patients consecutively admitted to a private institution between May 2019 and May 2020 were invited to participate in the study. The program consisted in a 12-month set of psychosocial, medical and recreative interventions requiring an attendance of at least 9 hours per week. Efficacy was evaluated at admission and every three months by the Addiction Severity Index (ASI). Quality of life was evaluated at admission and at the end of the treatment by the WHOQOL-Bref questionnaire. A comparison of parameters obtained at admission between the group that completed and the one that abandonned the treatment was also performed to detect potential predictors of early dropout. Six months after the end of the treatment, the participants were contacted in order to repeat an evaluation through the ASI and the WHOQOL-Bref scales. RESULTS: 41 participants (73% male, age 42.8 ± 16 years) were included. 14 participants dropped out at a median time of 88 days. Among those who completed the treatment improvements were observed in different clinical dimensions: in alcohol and drug consumption (3 months), in medical problems (6 months), in family/social relationships (9 months), in psychological scores (12 months) and in the four dimensions of WHOQOL-Bref. No changes were observed in legal problems and in the employment status. Only legal problems and family/social relationships at admission were significantly different among patients who completed versus those who dropped-out. Six months after discharge, no differences in WHOQOL-Bref scores were observed in the 15 participants who could be located and accepted the assessment. A little but statistically significant worsening was observed in the psychological problems dimension of the ASI in post-discharge follow-up. The rest of the ASI dimensions remained unchanged 6 months after concluding the treatment. CONCLUSION: This is one of the few studies performed in a latinamerican setting assessing the efficacy of a long-term IOT for SUD. It confirms previous works from developed countries, showing the potential benefits of IOTs implementation in our region.

OBJETIVO: Evaluar la eficacia de un tratamiento ambulatorio intensivo (TAI) para el trastorno por uso de sustancias (TUS) utilizando un enfoque multidimensional. Métodos: Se incluyeron todos los pacientes admitidos consecutivamente en una institución privada entre mayo de 2019 y mayo de 2020. El programa duró 12 meses y consistió en un conjunto de intervenciones médicas, psicosociales y recreativas, con una intensidad ≥ 9 horas/semana. La eficacia fue evaluada comparando los puntajes en el Índice de Severidad de Adicción (ASI) a lo largo del programa y en el cuestionario WHOQOL-Bref al inicio y al finalizar. En 15 pacientes se realizó una nueva medición seis meses después de concluido el tratamiento. MÉTODOS: Se incluyeron todos los pacientes admitidos consecutivamente en una institución privada entre mayo de 2019 y mayo de 2020. El programa duró 12 meses y consistió en un conjunto de intervenciones médicas, psicosociales y recreativas, con una intensidad ≥ 9 horas/semana. La eficacia fue evaluada comparando los puntajes en el Índice de Severidad de Adicción (ASI) a lo largo del programa y en el cuestionario WHOQOL-Bref al inicio y al finalizar. En 15 pacientes se realizó una nueva medición seis meses después de concluido el tratamiento. RESULTADOS: Se incluyeron 41 participantes (73% hombres, edad 42,8 ± 16 años). 14 participantes abandonaron (media 88 días). En los participantes que completaron el tratamiento, se observaron mejoras en los índices de alcohol y drogas (a los 3 meses), en problemas médicos (a los 6 meses), en las relaciones sociales y familiares (a los 9 meses) y en problemas psicológicos (a los 12 meses) así como  en las cuatro dimensiones del WHOQOL-Bref. Estas mejoras persistieron en la evaluación 6 meses post-alta cuando sólo un empeoramiento leve en la dimensión de problemas psicológicos del ASI fue objetivado. Conclusión: Este es uno de los pocos estudios realizados en un ámbito latinoamericano que evalúa la eficacia de un TAI para el TUS. Confirma trabajos previos de países desarrollados, mostrando los beneficios potenciales de la implementación de TAIs en nuestra región. CONCLUSIÓN: Este es uno de los pocos estudios realizados en un ámbito latinoamericano que evalúa la eficacia de un TAI para el TUS. Confirma trabajos previos de países desarrollados, mostrando los beneficios potenciales de la implementación de TAIs en nuestra región.

Exploring Differences in Baseline Characteristics among Adults Entering Integrated Residential Treatment for Co-occurring Disorders in 2013 and 2017.

Little is known about patients' addiction severity, substance use, or mental health symptoms upon entering integrated treatment. This is the first study to compare baseline characteristics among cohorts of patients with co-occurring disorders entering a private integrated residential treatment program in 2013 and 2017; a period when severe and persistent mental illness diagnoses, mental health service use, and overdose deaths increased. Our sample includes 3400 patients entering private, integrated residential treatment during 2013 (n = 1535) and 2017 (n = 1865). Trained staff completed admission interviews of all participants that included the Addiction Severity Index (ASI), a semi-structured interview to evaluate the past 30-day functioning of the following domains: medical, employment, alcohol, drug, legal, family or social support systems, and psychiatric. We used a p-value of 0.05 to assess significance. With the exception of the drug composite score, the 2017 cohort scored higher than the 2013 cohort on all other composite scores. Compared to the 2013 cohort, the 2017 cohort reported more days using alcohol, cocaine, amphetamines, and engaging in polysubstance use. Conversely, the 2017 cohort reported fewer days using other prescription opioids and sedatives than the 2013 cohort. After controlling for age, the 2017 cohort reported more days of marijuana use than the 2013 cohort. The 2017 cohort reported higher rates of the following symptoms: depression, anxiety, hallucinations, and suicidal ideation. Findings underscore differences among integrated treatment patient cohorts for baseline addiction severity, substance use, or mental health symptoms.

The association between history of civil commitment for severe substance use and future imprisonment: A Swedish registry study.

BACKGROUND: Civil commitment for individuals with severe substance use is fairly common and a part of many treatment systems worldwide. In Sweden, individuals with severe substance use and experience with civil commitment are more likely to use higher levels of alcohol and drugs, to be younger, and be more socially marginalized compared to their counterparts. The study examined whether civil commitments for severe substance use increased the likelihood of imprisonment following the civil commitment. METHOD: Baseline ASI-data merged with national registry data on prison sentences (2007 through 2016). Cox regression was used to estimate, for a Swedish sample of 12,044 adults assessed for risky substance use, the importance of having a history of civil commitment for severe substance use, controlling for age, gender and baseline assessment of ASI composite scores in seven areas (alcohol, drugs other than alcohol, legal, mental- and physical health, family & social relationships and employment) on the likelihood of future imprisonment. RESULTS: The regression showed that being a male, those with experience of civil commitment and elevated ASI composite scores for both legal and employment were significantly associated with imprisonment post-civil commitment. Civil commitment for severe substance use showed 1.29 (HR = 1.29, 95% CI: 1.03-1.49, p < 0.001) increased likelihood of imprisonment post-civil commitment. CONCLUSION: Having been in treatment through civil commitment due to severe substance use was strongly associated with imprisonment post-civil commitment episode. This is concerning since civil commitment is supposed to mediate against the consequences of severe substance use and promote voluntary treatment participation. Those with severe substance use and a history of civil commitment are in need of a well-coordinated and integrated system of extensive aftercare services to reduce the likelihood of imprisonment.

Detecting change in psychiatric functioning in clinical trials for cocaine use disorder: sensitivity of the Addiction Severity Index and Brief Symptom Inventory.

BACKGROUND: Assessment instruments commonly used in clinical trials to measure functional outcomes in substance users may lack sensitivity to detect change during treatment, potentially limiting findings regarding benefits of reduced drug use. This study evaluated the sensitivity of the Addiction Severity Index (ASI) to detect change in psychiatric functioning among cocaine users. METHODS: Data were pooled across five clinical trials for cocaine use disorder (N = 492) that included a 12-week treatment period and 6-month follow-up. Within-person cohen's d' was used to evaluate effect size of change on the Psychiatric Composite Score of the ASI (ASI-Psych) and Global Severity Index (GSI) of the Brief Symptom Inventory, as well as cocaine use. RESULTS: Effect sizes were larger for GSI than ASI-Psych from baseline to week 12 (GSI d' = 0.59; ASI-Psych d' = 0.16), and 6-month follow-up (GSI d' = 0.48; ASI-Psych d' = 0.10). For those with non-zero ASI-Psych at baseline (n = 252), medium effect sizes were found over the 12-week period (d' = 0.53) and 6-month follow-up (d' = 0.47). Effect sizes for change in days of cocaine use were most similar to GSI in either sample. CONCLUSIONS: The ASI Psychiatric Composite Score may have limited sensitivity to detect change in psychiatric functioning among clinical trial participants who reduce cocaine use. It may be useful for detecting change amongst those reporting some psychiatric problems at the start of treatment. Future research should consider an instrument's sensitivity to change when assessing the potential functional benefits of reducing cocaine use.

Factors affecting addiction severity index (ASI) among clients enrolled in methadone maintenance treatment (MMT) program in Myanmar.

BACKGROUND: Opioid substitution with methadone maintenance treatment (MMT) is shown to reduce illicit opioid use and renew social functioning. Understanding factors that undermine clients' social functioning during MMT treatment is vital for improving treatment compliance and quality of life. METHOD: A total of 210 respondents who were already enrolled in a formal MMT program in Myanmar were recruited from five cities through stratified random sampling for this cross-sectional study. The addiction severity index (ASI) was used to objectively assess respondents social functioning in the last 30 days. Higher ASI scores denote poorer social functioning. RESULT: Respondents total ASI scores in the respective domains were: employment (47.4%), alcohol (44.4%), drug use (7.2%), legal (49.2%) and social-family relationship (10.7%). Those reported to have never injected drugs in the last 30 days had lower ASI total scores than those who reported injection drug use (p = 0.01). After identifying the differences in ASI total scores, we found there were significant associations in the clients' hepatitis C status, age category, frequency of heroin injection, quality of life score, marital status, current leisure status with family/friend, current history of injection in the last 30 days, income status, satisfaction with current marital status, as well as reported drug and alcohol use (p < 0.05). Stepwise binary logistic regression showed that alcohol and higher frequency of heroin injection were associated with higher ASI scores. Meanwhile, older age, respondents those who had leisure time with family, and satisfied with current marital status had lower ASI scores (p < 0.05). CONCLUSION: Our results indicate that those enrolled in the MMT program in Myanmar faced many challenges in their daily social functioning. Treatment providers must take heed of these apparent impediment to ensure clients chequered social functioning does not undermine their treatment compliance. TRIAL REGISTRATION: NA.

Long-term functioning to provide empirical support for the clinical relevance of treatment outcomes for methamphetamine use disorders.

BACKGROUND: Research has yet to empirically evaluate methamphetamine (MA) use outcome measures commonly used to indicate treatment success. Clinically meaningful outcomes must be associated with long-term functioning in important life domains. This study evaluated the association between different MA use outcomes and long-term life-functioning. METHOD: The data that this study used in its secondary analyses were pooled from two treatment trials for MA use disorders (n = 237). The study conducted multiple regression analyses (with multiple imputation for missing data) to determine the association of six within-treatment MA use outcome measures with problem severity in seven life domains and a proxy measure for overall functioning, measured with the Addiction Severity Index (ASI) and assessed at an 8-month follow-up. RESULTS: The longest duration of abstinence (LDA) outcome achieved the most consistent performance, being associated with better scores in five of eight ASI outcomes (ß ranging from -0.203 to -0.291; p < .01). The complete abstinence during treatment demonstrated the poorest performance and was not significantly associated with any of the ASI outcomes. All other MA use outcome measures were significantly (p < .01) associated with at least one ASI outcome. CONCLUSION: This study provides empirical support for the use of LDA as a clinically relevant indicator of treatment success for MA use disorders, while also indicating the limitations of using complete abstinence during treatment to determine treatment success. Based on these findings, providers and researchers should use LDA as a primary outcome for MA use disorder treatments and trials.

Does anxiety sensitivity predict addiction severity in opioid use disorder?

Increased anxiety sensitivity (AS), or the fear of anxiety-related cognitive, social, and physical symptoms which are misinterpreted as having harmful implications, has shown a relationship with substance use disorders. People with substance use disorders also experience addiction-related problems across domains of life functioning. However, few studies have evaluated the relationship between elevated AS and addiction-related problems across specific life areas. We evaluated, first, whether AS predicted addiction-related problems in a sample of treatment-refractory outpatients with opioid use disorders and, second, whether sex moderated the relationship between AS and addiction-related problems in this sample. Participants with treatment-refractory opioid use disorders (n = 92, 53.3% male) completed baseline assessments of AS (the Anxiety Sensitivity Index) and addiction-related problems (the Addiction Severity Index). Baseline AS total score was a significant independent predictor of both baseline Addiction Severity Index medical status (ß = 0.29, t = 2.84, p = .006) and psychiatric status (ß = 0.30, t = 2.99, p = .004) composite scores but was not associated with social, employment or legal difficulties. These findings were maintained when controlling for drug use severity, though baseline AS total score became a significant predictor of baseline legal difficulties (ß = -0.23, t = -2.25, p = .027). There was no moderating role of sex on the relationship between baseline AS and addiction-related problems. Our findings suggest that, regardless of sex, elevated AS predicts increased addiction-related medical and psychiatric problems, and decreased legal problems when accounting for drug use severity, in outpatients with opioid use disorders.

The predictability of the Addiction Severity Index criminal justice assessment instrument and future imprisonment: A Swedish registry study with a national sample of adults with risky substance use.

OBJECTIVE: In Sweden, social workers uses the Addiction Severity Index (ASI) as their main assessment tool when assessing individuals with risky substance use (RSU) or substance use disorder. The aim of this study is to identify among individuals with RSU, the associations of ASI Composite Scores (CSs) with future imprisonment controlling for age, education level and gender. METHOD: Baseline ASI-data was merged with national registry data on prison sentences (2003-2016). Cox regression was used to estimate the associations between CSs for alcohol, drugs other than alcohol, legal, family and social relationships, employment, mental- and physical health and future imprisonment for adults (n = 14,914) assessed for RSU. RESULTS: The regression showed that all ASI CSs, age, education level and gender were significantly associated with imprisonment post ASI base-line assessment. The variables with the strongest association with imprisonment were ASI legal CS, followed by ASI drugs other than alcohol CS, ASI employment CS and being a male. ASI legal score showed the strongest association with imprisonment, with a 6 time increase in likelihood of imprisonment. DISCUSSION: Given the findings in this study, the strong significant association between ASI legal CS and future imprisonment, it seems as that the ASI-assessment instrument is a reliable and trustworthy assessment tool to use in clinical work. This should motivate social workers and other clinical health professionals to use and rely on the ASI assessment in their intervention planning for clients with RSU, to hopefully reduce future imprisonment and improve their social situation.

Convergent Validity of Self-Administered Addiction Severity Index in a Sample of Nigerian Patients in a Residential Treatment Facility.

BACKGROUND: Substance use disorders present with multiple drug-related problems that need to be evaluated with a view to planning and administering holistic interventions that could potentially improve addiction treatment outcomes. Many valid instruments are available for assessing the problems that occur in addiction but most of them require some training and they take a lot of time to administer. This study validates a shorter self-administered version of the Addiction severity Index (ASI) against the Clinician-administered ASI with a view to cutting the time needed to administer the instrument. METHODS: The study recruited 142 patients in a residential treatment center. Correlation coefficient and t-test were used to assess for the convergence of the two version. RESULTS: The correlation coefficients ranged from 0.52 to 0.97 for the different domain of the ASI with higher endorsement of problems in the self-administered than clinician administered version in most domains. CONCLUSION: The self-administered ASI is a valid alternative to the clinician-administered ASI and it saves valuable time especially in resource-constrained settings.

Validation of Addiction Severity Index (ASI) for Assessment of Psychiatric Comorbidity in Multi-Site Randomized Controlled Trials.

Objective: This study aimed to assess the validity of the psychiatric problems subscale of the Addiction Severity Index (ASI-psych) to ascertain psychiatric comorbidity among individuals participating in randomized controlled trials (RCTs) of substance use disorder (SUD) treatments.Methods: The ASI-psych score among 1,660 RCT participants of National Institute of Drug Abuse Clinical Trials Network studies was compared against diagnosis of any serious mental disorder based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (SCID) or Mini-International Neuropsychiatric Interview (MINI). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for detecting any serious mental disorders were estimated by the receiver operating characteristic (ROC) analysis.Results: Based on the overall sample, the AUC score for any serious mental disorder was 0.72 (95% confidence interval [CI], [0.69, 0.75]) with the optimal ASI-psych score of 24.6. There was no statistically significant difference in AUCs based on the SCID and MINI (χ2 = 0.05, p = .82) or by target drugs of RCTs (χ2 =1.33, p = .72).Conclusions: Results support the utility of the ASI in screening for psychiatric comorbidity among patients receiving SUD treatments in RCT settings.

The Associations between Risky Psychosocial Environment, Substance Addiction Severity and Imprisonment: A Swedish Registry Study.

Objective: Both childhood and adult psychosocial stressors have been identified as links to both increased risk for substance use disorder (SUD) and increased risk of imprisonment. The aim of this retrospective study is to identify, for a sample of 14,914 adults who all were assessed for risky substance use or a SUD, the importance of having a history of psychosocial stressors compared to current addiction severity. The analyses control for age, gender and education on the likelihood of future imprisonment. Method: Baseline Addiction Severity Index data (ASI) were merged with national registry data on prison sentences from 2003 to 2016. In the analysis, a Cox regression was used to study the association between independent variables and the likelihood of future imprisonment. Results: In the regression, five variables showed significant association to increased risk of imprisonment: ASI drugs other than alcohol Composite Score (positive relationship), ASI alcohol Composite Score (negative relationship), age (younger), education (lower) and parental problems with drugs other than alcohol. The factor with strongest association with imprisonment was the ASI drugs other than alcohol Composite Score, which showed the highest HR = 10.63 (3.50-32.31) for women and HR = 5.52 (3.77-8.08) for men to predict the likelihood of imprisonment. Discussion: Research is needed on why individuals with history of psychosocial stressors have a higher likelihood of imprisonment compared to their counterparts. Findings indicate that a high ASI Composite Score for drugs other than alcohol are strong predictors of future criminality and criminal justice system involvement.

A Swedish national study: Immigrant-country of birth status and child welfare compulsory care among a sample of parents with risky substance use.

BACKGROUND: Sweden has a high percentage of foreign-born residents (18.5 %) and one of the highest overdose death rates in Europe. For immigrant parents with risky substance use (RSU), risk factors associated with immigration status (e.g., economic strain and psychological stress) potentially heightening the risk of involvement with the child welfare system (CWS). Using Swedish registry national data, this study explored the relationship between immigration-country of birth status, psychosocial risk factors, and child compulsory care for parents with RSU. METHODS: Study sample consisted of 5932 parents from 65 Swedish municipalities assessed for psychosocial problems (including alcohol and drug use) using the Addiction Severity Index (2007-2017). Stepwise multinomial logistic regression models examined the relationship between immigration-country of birth status (Swedish born, Nordic-born, and non-Nordic born), psychosocial problems, and compulsory care in the CWS. RESULTS: Compared to Swedish-born parents, parents not born in Sweden, Norway, Denmark or Finland (non-Nordic born parents) had a lower probability of children living in compulsory care (family homes or institutions). However, after accounting for psychosocial problems, immigration status was no longer significantly associated with children's living arrangements. CONCLUSIONS: Study findings indicate that parental immigrant status (even among parents dealing with RSU) in itself is not a risk factor for compulsory care in the CWS. Moreover, parental employment and health problems posed greater risk for children being in compulsory care. Receipt of targeted services for employment and health problems may help to maintain stable child living arrangements for immigrant parents dealing with RSU.

Reliability of the Addiction Severity Index self-report form (ASI-SR): a self-administered questionnaire based on the Addiction Severity Index composite score domains.

Objectives: The Addiction Severity Index (ASI) is a standardized interview used to assess problems associated with substance use. Although widely used, the time required for the interview remains an obstacle to its acceptance in many clinical settings. We examined if a self-administered questionnaire based on the composite score (CS) items, the ASI Self-Report form (ASI-SR), offers a reliable alternative to the ASI in assessing current substance use and related problems.Methods: Participants were 59 treatment seeking individuals entering outpatient programs at the Addiction Psychiatric Clinic at Uppsala University Hospital who were assessed with Swedish versions of the ASI and ASI-SR. Agreement between the ASI interview's CS and ASI-SR's CS was evaluated on the individual basis by intraclass correlation analysis (ICC) and on group level with the Wilcoxon signed rank test. Reliability and internal consistency were evaluated using Cronbach's alpha.Results: For 6 out of 7 CS domains, the ICC for the ASI interview and ASI-SR were good to excellent. Internal consistency was acceptable for 6 out of 7 CS domains on the ASI interview and for 5 out of 7 CS domains on the ASI-SR.Conclusions: The present study suggests that the ASI-SR is a reliable alternative to the ASI interview for assessing current patient functioning and evaluation of problems related to alcohol and drug use.