The Addiction Severity Index (ASI) Across Cultures

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2005 NIDA International ForumJune 17th, 2005

Workshop II - The Ireland Room B

Thanks to NIDA:Steve Gust & Erin Winstanley

The Addiction Severity Index (ASI) Across Cultures

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Today’s Presenters:

Selection, Modification and Inter-rater Reliability on the use of the ASI in Egypt

Sample: Adult Inpatient Hospital Program in Cairo

Nasser Loza, Egypt

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Elaborating and using the ASI across different national realities and treatment conditions – The EuropASI in Greek Treatment Programmes

Sample: Adults in 6 Drug-Free Therapeutic Communities in Greece

Gerasimos Papanastasatos, Greece

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Understanding the Israeli addict population – ASI profiles of former Soviet Union and native Israeli opiate abusers

Sample – Adults in detoxification, day treatment and methadone maintenance programs

Richard Isralowitz, Israel

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Incorporating the ASI: Exploring assessment and outcomes in a residential treatment facility in Northern Ireland

Sample: Adult Residential Treatment Facility in Northern Ireland

Debra Wilson & Pauline Murnin, Ireland

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The Brazilian experience on the implementation of the ASI – where are we right now?

Sample: Adult Cocaine Abusers @ HIV clinics in Brazil and a Validity Study of the ASI 6

Flavio Pechansky, Brazil

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Experiences using the ASI in different

countries.

and…

Richard Rawson, USA

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ASI International Use and Data

from 10 Countries

Deni Carise, USA

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IntroductionIntroduction

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In addition to those presenting here,

researchers and clinicians in the following countries have

used the ASI:

The ASI has been translated and modified for use in many countries.

IntroductionCountries

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ThailandScotlandHungaryUkraine

The NetherlandsSweden

IranPakistan

SpainItaly

BelgiumCanada

The CaribbeanChile

Guatemala MoroccoTunisiaPortugalRussiaNorway

IntroductionDeni’s Presentation

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Today, data are presented from the US Drug Evaluation Network System

and various samples in:Belgium BrazilGreece IrelandItaly NorwayRussia Scotland

Sweden

Data Sets

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Introduction

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Data Sets

USA Deni Carise & A. Thomas McLellan8,479 patients from 14 inpatient/ residential, 4 methadonemaintenance and 18 out-patient treatment programs

Brazil Flavio Pechansky & Felix Kessler193 cocaine-dependent clients from 3 HIV Clinics

Introduction

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Data Sets

Greece Gerasimos Papanastasatos & Erianna Daliani

500 clients from 4 residential and 2 OP programs

Ireland Debra Wilson & Pauline Murnin162 clients from 1 inpatient program

IntroductionData Sets

Belgium1 Joke De Wilde117 Clients from 4 adult residential drug-free TC’s

Belgium2 Veerle Raes3,712 clients from a large

drug addiction treatmentprogram

Italy Joke De Wilde101 clients from 5 adult residential drug-free TC’s

Norway Edle Ravndal482 clients from 10 IP, 4 MM, 3 OP youth and 4 youth “collectives”.

Russia Evgeny Krupitsky332 clients from 1 adult hospital detox & treatment program.

Data Sets

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Scotland Rowdy Yates134 clients from 1 adult OP

drug treatment program.

Sweden Jonas Larsson, David Oberg & Bjorn Sallmen201 prisoners from 16 SA prison-based treatment programs

Data Sets

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Data Sets

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• AgeAge• GenderGender• Alcohol & Drug Composite Alcohol & Drug Composite

scoresscores• Days heavy drinking Days heavy drinking • Days used marijuana Days used marijuana • Days used cocaineDays used cocaine

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Data Presented:

Medical, Psychiatric, Family and Medical, Psychiatric, Family and Legal:Legal:

• Composite ScoresComposite Scores• Days problems Days problems • Days conflictsDays conflicts• Percent reporting symptomsPercent reporting symptoms• Illegal behaviorIllegal behavior• Employment variablesEmployment variables

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Data Presented:

International DataSample N Age (SD) % Male

Belgium1 117 24 (6) 84

Brazil 193 - 89

Greece 500 26 (5) 84

Ireland 162 41 (10) 69

Italy 101 28 (4) 88

Norway 482 31 (8) 67

Russia 332 23 (0) 74

Scotland 134 27 (6) 68

Sweden 201 36 (11) 95

U.S.A. 8429 35 (11) 66

International Data – Drug & Alcohol

Alc. CS Drink 5+

Drg. CS Cocaine Cannabis

Belgium1 .11 (.19) 2 (5) .17 (.13) 1 (5) 5 (8)

Brazil .25 (.20) 10 (9) .19 (.10) 13 (10) 21 (11)

Greece - 0 (2) .21 (.11) 0 (2) 2 (6)

Ireland .67 (.26) 16 (10) .07 (.14) 0 (1) 3 (8)

Italy .20 (.27) 6 (11) .26 (.17) 2 (6) 8 (12)

Norway .08 (.14) 2 (6) .31 (.13) 0 (3) 10 (12)

Russia .28 (.00) - .08 (.01) - -

Scotland .07 (.18) 4 (9) .43 (.09) 1 (4) 16 (13)

Sweden .52 (.28) 13 (12) .05 (.09) 1 (4) 2 (7)

U.S.A. .21 (.26) 3 (7) .12 (.13) 3 (7) 2 (6)

International Data – Medical & Psychiatric

Med. CS Med. Prob. Psy. CS % Dep. Psy. Prob.

Belgium1 .35 (.32) 10 (12) .49 (.24) 38 13 (12)

Brazil .24 (.28) 12 (9) .23 (.22) 21 15 (11)

Greece .21 (.29) 4 (8) .21 (.18) 21 9 (11)

Ireland .40 (.41) 11 (13) .48 (.26) 59 18 (13)

Italy .17 (.23) 2 (6) .38 (.26) 27 9 (12)

Norway .25 (.32) 8 (12) .27 (.23) 33 11 (13)

Russia .23 (.01) - .25 (.01) - -

Scotland .34 (.39) 8 (5) .32 (.26) 64 11 (12)

Sweden .34 (.37) 10 (14) .24 (.21) 28 9 (13)

U.S.A. .17 (.30) 5 (10) .19 (.23) 30 8 (11)

International Data – Family & LegalFam. CS Conflicts Leg. CS Illegal Act Work Emp. Prob.

Belgium1 .20 (.22)

2 (6) .34 (.23) 2 (7) 2 (5) 4 (8)

Brazil .24 (.21)

10 (10) .12 (.17) 8 (9) 22 (9) 9 (10)

Greece .34 (.20)

5 (9) - 1 (5) 3 (8) 5 (13)

Ireland .29 (.26)

7 (11) .09 (.19) 0 (3) 4 (8) 6 (11)

Italy .36 (.26)

7 (11) .30 (.29) 6 (10) 4 (9) 1 (1)

Norway .16 (.19)

4 (9) .31 (.28) 10 (13) 5 (10) 3 (9)

Russia .41 (.01)

- .17 (.02) - - -

Scotland .38 (.23)

6 (8) .40 (.25) 17 (13) 1 (5) 9 (11)

Sweden .18 (.20)

3 (8) .28 (.13) 4 (10) 5 (10) 8 (13)

U.S.A. .16 (.21)

3 (7) .18 (.21) 1 (4) 8 (10) 8 (12)

Belgium2 Veerle RaesData collected 1998 - 2004

3,712 interviews

383 Inpatient; 3,329 Outpatient

All collected from a large “illegal drug addiction treatment program” (may under-represent alcohol use).

Larger Belgium Data Set

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USA vs. Belgium Data by Modality

U.S.A. (IP) Belgium2 (IP) U.S.A. (OP) Belgium2 (OP)

Sample N 3,133 383 3,885 3,329

Age (SD) 36 (11) 25 (6) 33 (10) 27 (7)

% Male 71 86 77 82

Alc. CS .33 (.27) .1 (.2) .16 (.23) .1 (.1)

Drink 5+ 5 (9) 2 (5) 2 (6) 3 (6)

Drg. CS .11 (.14) .2 (.1) .09 (.11) .2 (.1)

Cocaine 3 (8) 2 (5) 2 (6) 2 (5)

Cannabis 2 (6) 4 (8) 2 (6) 11 (12)

USA vs. Belgium Data by Modality

U.S.A. (IP) Belgium2 (IP) U.S.A. (OP) Belgium2 (OP)

Med. CS .16 (.29) .3 (.3) .15 (.28) .2 (.3)

Med. Prob. 4 (9) 8 (11) 5 (10) 7 (11)

Psy. CS .20 (.24) .3 (.2) .16 (.22) .2 (.2)

% Dep. 31 34 25 30

Psy. Prob. 8 (12) 14 (12) 6 (11) 10 (11)

Fam. CS .15 (.21) .3 (.2) .13 (.20) .1 (.2)

Conflicts 3 (8) 3 (8) 2 (7) 2 (6)

Leg. CS .20 (.22) .3 (.2) .18 (.20) .2 (.2)

Illegal Act 1 (5) 3 (7) 1 (4) 1 (5)

Work 8 (10) 1 (5) 9 (11) 8 (11)

Emp. Prob. 8 (12) 3 (8) 9 (12) 5 (10)

Conclusions

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Conclusions

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Data presented just for discussion - No conclusions please!

Data were collected from too many different locations (prisons, HIV clinics, in patient,

outpatient treatment programs) and from too many different samples (opiate only users,

primary alcohol users, an all inpatient sample, an outpatient only sample, etc.) for valid

comparisons to be made.

Limitations

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The End

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