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Aims This study performs the first cost-effectiveness analysis (CEA) of Recovery Management Checkups (RMC) for adults with chronic substance use disorders. Design Cost-effectiveness analysis of a randomized clinical trial of RMC. Participants were assigned randomly to a control condition of outcome monitoring (OM-only) or the experimental condition OM-plus-RMC, with quarterly follow-up for 4 years. Setting Participants were recruited from the largest central intake unit for substance abuse treatment in Chicago, Illinois, USA. Participants A total of 446 participants who were 38 years old on average, 54% male, and predominantly African American (85%). Measurements Data on the quarterly cost per participant come from a previous study of OM and RMC intervention costs. Effectiveness is measured as the number of days of abstinence and number of substance use-related problems. Findings Over the 4-year trial, OM-plus-RMC cost on average $2184 more than OM-only (P

Aims This study compared assertive continuing care (ACC) to usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence. Outcome analyses tested the direct and indirect effects of both conditions and level of adherence on early (months 1–3) and longer-term (months 4–9) abstinence. Design Two-group randomized design. Setting Eleven counties surrounding a community-based residential treatment program in the Midwestern section of the United States. Participants A total of 183 adolescents, ages 12–17 years, with one or more Diagnostic and Statistical Manual version IV (DSM-IV) substance use dependence disorder and met American Society for Addiction Medicine (ASAM) placement criteria for non-medical residential treatment. Intervention Prior to discharge from residential treatment, participants were assigned randomly to receive either UCC, available at outpatient clinics in the 11-county study area, or ACC via home visits. Measurements Self-reported interview data were collected at intake, 3, 6 and 9 months post-residential discharge. Urine test data and interviews with a caregiver were conducted at baseline and 3 months. Findings ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence. Conclusions ACC appears to be an effective alternative to UCC for linking, retaining and increasing adherence to continuing care. Replication with larger samples is needed to investigate further the direct and indirect effects of ACC found in this study.

The Global Appraisal of Individual Needs (GAIN)1 is a 1–2 hour standardized biopsychosocial that integrates clinical and research assessment for people presenting to substance abuse treatment. The GAIN – Short Screener (GSS) is 3–5 minute screener to quickly identify those who would have a disorder based on the full 60–120 minute GAIN and triage the problem and kind of intervention they are likely to need along four dimensions (internalizing disorders, externalizing disorders, substance disorders, and crime/violence). Data were collected from 6,177 adolescents and 1,805 adults as part of 77 studies in three dozen locations around the United States that used the GAIN. For both adolescents and adults the 20-item total disorder screener (TDScr) and its four 5-item sub-screeners (internalizing disorders, externalizing disorders, substance disorders, and crime/violence) has good internal consistency (alpha of .96 on total screener), is highly correlated (r = .84 to .94) with the 123-item longer scales in the full GAIN. The GSS also does well in terms of its receiver operator characteristics (90% or more under the curve in all analyses) and has clinical decision-making cut points with excellent sensitivity (90% or more) for identifying people with a disorder and excellent specificity (92% or more) for correctly ruling out people who did not have a disorder. The GSS has good potential as an efficient screener for identifying people with co-occurring disorders across multiple systems and routing them to the right services and more detailed assessments.

Aims To examine the comparability, reliability and predictive validity of two instruments used to assess alcohol use and dependence: the Global Appraisal of Individual Needs (GAIN) and the Form 90 Timeline Followback (TLFB) method. Design, setting and participants Adolescents (n = 101) admitted to a residential treatment program in the United States were interviewed at intake with the GAIN, and again within a week with a variation of TLFB, called Form 90. Alcohol and cannabis measures were compared and used to predict the number of past-month substance abuse and dependence symptoms. Measurement Self-report measures of days of alcohol and cannabis use in the 90 days prior to intake, peak number of drinks/joints used, peak blood alcohol content (BAC) and alcohol and cannabis abuse and dependence symptom counts. Findings Results revealed that the measures had: (a) excellent comparability (r = 0.7–0.8) across the two instruments; (b) deteriorating reliability after reported peak BAC levels exceeded 0.50 and peak joints exceeding 19; and (c) similar and strong relationships between use measures and the number of abuse/dependence symptoms across measures and instruments. Conclusions In a sample of 101 adolescents who were admitted to residential treatment for alcohol or drug dependence, the corresponding measures from the two instruments produced comparable results. If the cross-validation of these two measures generalizes to adolescents treated in out-patient settings and other adolescent treatment populations, the GAIN and Form 90 may provide useful core alcohol measures for meta-analyses.