Clinical and Reliable Change in an Australian Residential Substance Use Program Using the Addiction Severity Index

Abstract

Although the Addiction Severity Index (ASI) is one of the most frequently used measures in alcohol and other drug research, it has rarely been used to assess clinical and reliable change. This study assessed clients' clinical and reliable change at The Salvation Army residential substance abuse treatment centers in Australia. A total of 296 clients completed ASI interviews on admission to treatment and 3 months after discharge from treatment. Clients demonstrated significant improvement on all seven ASI composites. The range of reliable change for each ASI composite varied from 30% to 70%. More than two-thirds of clients experienced clinically significant improvement for alcohol and drug problems. Psychiatric distress was clinically reduced in 44% of clients. This research indicates that residential substance abuse treatment can make important differences in client's lives at a clinical and functional level. However, the research highlights the challenge of effectively targeting psychiatric comorbidity within alcohol and other drug abuse populations.

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

“…Baseline scores on this subscale (mean OTI = 20) were comparable to similar psychosocially complex substance-dependent groups (34). Psychiatric symptoms as measured by the ASI improved by 44% from baseline at 9 months post-exit, comparable to other TC studies [8,49]. However, Psychiatric Status at baseline in this cohort (mean = 0.6) was substantially worse than a range of different substance dependent cohorts in both TC and non-TC service settings: M = 0.3 in (45); M = 0.4 in (8); M = 0.2 in [48].…”

“…However, Psychiatric Status at baseline in this cohort (mean = 0.6) was substantially worse than a range of different substance dependent cohorts in both TC and non-TC service settings: M = 0.3 in (45); M = 0.4 in (8); M = 0.2 in [48]. Employment Status improved by 19%, similar to those following residential treatment in a recent TC study [8]. Although promising, this outcome is low compared with substantial improvements in the other outcome variables, and suggests that re-entering the employment market following lengthy residential treatment may be particularly challenging, and requires additional targeted support.…”

“…TC effectiveness is typically assessed by rates of abstinence from drugs or alcohol, or various measures that indicate a substantial reduction (e.g., 50%) in use and related harm. However, there is an increasing focus on reporting psychosocial outcomes, consistent with TC philosophy [7][8][9], although most reviews tend to focus on substance use outcomes only. Systematic reviews of TC outcomes have generally found support for their effectiveness across a wide range of populations and contexts [10,11].…”

Measuring both primary and secondary outcomes when evaluating treatment effectiveness in alcohol and drug treatment programmes

“…Finally, the present study examined salient and clinical change by comparing change in terms of group means. Comparing group means has noted limitations in that it does not assess change at the individual level (Bowersox, Saunders, & Wojcik, 2009;Deane et al, 2013;Jacobson & Truax, 1991). Additional analyses that include measuring clinical and reliable change at the individual level would be useful in terms of future studies (see Deane et al, 2013 for an example).…”

“…These consequential factors have a high burden of cost for the individual, his or her family, and society (Baumberg, 2006;Lander, Howsare, & Byrne, 2013). Researchers now argue that it is important for these consequential factors to be taken into account when evaluating treatment effectiveness (Deane, Kelly, Crowe, Coulson, & Lyons, 2013;Donovan et al, 2012;Tiffany et al, 2012a;Tiffany, Friedman, Greenfield, Hasin, & Jackson, 2012b). That is, for treatment to be considered effective, it is not enough to demonstrate a reduction or elimination of substance use (i.e., primary outcome), treatment must also facilitate improvements in consequential factors (i.e., secondary outcomes), as these are meaningful and relevant at the clinical, personal, and societal level.…”