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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.Among people in the community with psychiatric and substance disorders, multiple cooccurring diagnoses are the norm. [2][3][4][5][6][7] Co-occurrence of psychiatric disorders, substance use disorders, and crime/violence are an even more prominent characteristic of those entering the addiction treatment, mental health services, and the criminal/juvenile justice system. 6,[8][9][10][11][12][13][14][15][16] Individuals with multiple co-occurring problems are more likely to experience problems with treatment and medication adherence, shorter lengths of stay, administrative discharges, functional status, community adjustment, quality of life, and worse outcomes following treatment for their substance use disorder. [17][18][19][20][21][22][23][24] Unfortunately, it is estimated that one-to two-thirds of people with serious disorders do not access treatment and most of those who are un-or under-treated are young males with poor education. 25 Among people with substance use disorders, less than 1 in 5 adults and 1 in 10 Address correspondence to Dr. Dennis, Chestnut Health Systems, 720 West Chestnut, Bloomington, IL 61701. mdennis@chestnut.org. The opinions are those of the author and do not reflect official positions of the contributing project directors or government. 26 While research suggests that 70 to 80% of people entering substance abuse treatment have one or more co-occurring psychiatric disorders only 16% of adults and 28% of adolescents have a co-occurring diso...

As the field follows recommendations to introduce standardized assessments on substance, mental and behavioral problems, a consistent picture has emerged that co-occurring disorders are common, that there is heterogeneity in the type of disorder, and that the pattern varies by age. This paper examines the prevalence of self-reported substance use and mental health problems, the pattern of comorbidity, and how both vary by age among people presenting to substance abuse treatment. Data are from 4,939 adolescents and 1,958 adults presenting to substance abuse treatment in multi-site studies who were assessed with the Global Appraisal of Individual Needs (GAIN) and categorized into five age groups: age <15, 15-17, 18-25, 26-39, and 40+. Two thirds of clients had a co-occurring mental problem in the year prior to treatment admission. Across all ages, clients self-reporting criteria for past-year substance dependence were more likely than those who did not to have other cooccurring mental health problems (odd ratios of 2.9 to 8.8). The prevalence and patterns of cooccurring mental health problems however varied by age. Young adults (age 18-25) were found to be most vulnerable to co-occurring problems.

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This article reviews progress in adapting addiction treatment to respond more fully to the chronic nature of most patients’ problems. After reviewing evidence that the natural history of addiction involves recurrent cycles of relapse and recovery, we discuss emerging approaches to recovery management, including techniques for improving the continuity of care, monitoring during periods of abstinence, and early reintervention; recent developments in the field related to self-management, mutual aid, and other recovery supports; and system-level interventions. We also address the importance of adjusting treatment funding and organizational structures to better meet the needs of individuals with a chronic disease.