Chapter 5 Subset of Overview by Age

Chapter 5Subset of Overview by

Age

GAIN Coordinating Center (11/21/2012).Normal, IL: Chestnut Health Systems. November 2012.

Available from www.gaincc.org/slides

Created for: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for

Substance Abuse Treatment (CSAT) under contract number 270-2012-00001

2

SAMHSA/CSAT Full GAIN Outcome Data Set

Sample: The 2011 SAMHSA/CSAT data set includes data on 29,782 clients from 230 local evaluations, recruited between 1997-2011 who were due for at least one follow-up and available in the last quarterly data set of 2011.

Levels of Care: Outpatient, Intensive Outpatient, Short-term & Moderate/Long-term Residential, Corrections-Based Treatment and Post-Treatment Continuing Care

Instrument: Global Appraisal of Individual Needs (GAIN) (see www.gaincc.org/gaini) Versions 3 (CYT & ATM) and 5.1 through 5.6

Follow-up: 89% with one or more follow-ups at 3, 6, 9 & 12 months post intake, and 66% with two or more

Funding: SAMHSA/CSAT contracts 270-07-0191 and 270-2012-00001 and 230 individual grants

(see Detailed Acknowledgement)

3

Age

18 -25 Years 13.4%

(n=3,976)

Under 15 Years (<15) 13.8%

(n=4,105)

15-17 Years 63.5%

(n=18,897)

26+ Years 9.4%

(n=2,804)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,782)

4

Risk and Protective Factors by Age The following slides present information on

demographics, and risk and protective factors by different age groups for clients at intake, including: Demographics Substance use Risk behaviors Victimization Mental health disorders Physical health problems Crime and violence Sources of stress and strengths Costs Summary indices (problem prevalence, quality of life, general

satisfaction) Non-client characteristics (program, level of care,

and type of treatment)

5

Gender by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

31%25% 28%

40%

69%75% 72%

60% Male

Female

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,771)

6

Race by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

15% 16% 16% 17%

32% 28% 31% 28%

4%4% 3% 3%

32% 38% 38% 45%

16% 14% 11% 7%

Multi-Racial

White

Other

Hispanic

African American

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,767)

7

Risk of Homelessness by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

84% 79%64%

47%

2% 3% 8% 13%

Currently Homeless

At Risk of Homeless-ness

Group/Inst

Housed

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,646)

8

Past Year Substance Severity by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

41%49% 51% 48%

PY De-pendence

PY Abuse

PY Use

No PY Use

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,358)

9

Primary Substance by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

24% 25% 30% 33%

65% 63%40%

9%

Other Drug

Opioids

Amphetamines

Cocaine

Marijuana

Alcohol

SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,716)

10

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%13%

23%30% 26%

High SU (6-8)

Moderate SU (3-5)

Low SU (0-2)

Number of Substance Problems by Age

SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,716)

11

Tobacco Diagnosis by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

26%37%

49% 51%

Dependence/Daily Use

Current PY Use

Past Use

Never Used

SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,384)

12

HIV Risk Scale* by Age

* Available at intake only.

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%12%

19%28% 31% High

Risk(10-36)

Moderate Risk(3-9)

Low Risk(0-2)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,746)

13

HIV Risk Change Index* by Age

*Can be used to measure change.

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%7% 9% 11% 6%

HighRisk(4-7)

ModerateRisk(2-3)

LowRisk(0-1)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,835)

14

Number of Sex Partners* by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%13% 17% 16%

6%

3+ Sex Partners

1-2 Sex Partners

No Sex Partners

*In the past 90 days

SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,751)

15

Severity of Victimization by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

39% 44%53% 59%

High Severity (4-15)

Moderate Severity (1-3)

Low Severity (0)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,501)

16

Mental Health Disorders by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

33% 34% 31% 26% Both

Internalizing Disorders Only

Externalizing Disorders Only

Neither

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,684)

17

Homicidal/Suicidal Thoughts by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 3% 3%2% 3%

#REF!

#REF!

#REF!

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,469)

18

Health Problems by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%7% 8% 10%

17%High Prob-lems(33-100)

Moderate Problems (10-32)

Low Prob-lems(0-9)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,477)

19

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$2,499 $2,451$2,663

$2,851

$7,600+

$1 - $7,599

$0

Mean

Health Care Utilization Cost* by Age

*Using 2011 Dollars

SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,481)

20

Crime & Violence by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

42% 39%26%

9%

High Crime(7-29)

Moderate Crime (3-6)

Low Crime(0-2)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,703)

21

Type of Crime by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

45% 43%

27%

9%

Violent Crime*

Other Crime**

Drug Use only

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,377)

* Violent crime includes assault, rape, murder, and arson.** Other crime includes vandalism, possession of stolen goods, forgery, and theft.

22

Cost of Crime* by Age

*Using 2011 Dollars

SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,405)

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

$900,000

$822,000

$569,572

$370,986

$45,668

$120,000+

$1-$119,000

$0

Mean

23

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Detention/jail 30+ days

Detention/jail 14-29 days

Drug Court

Prob/parole 14+ days w/ 1+ drug screens

Other probation, parole, detention

Other JJ/CJ status

Past arrest/JJ/CJ sta-tus

Past yr illegal activity/SA use

Intensity of Justice System Involvement by Age

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,617)

24

Count of Major Clinical Problems* at Intake by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

45% 48% 46% 42%

Five to Twelve

Four

Three

Two

One

None

*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,782)

25

Sources of Stress Index by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

34% 32%40%

50%

High Stress(3-15)

Moderate Stress(1-2)

Low Stress(0)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,592)

26

Treatment Readiness by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 5% 6% 4% 1%

Low Readiness (0-2)

ModerateReadiness (3-5)

High Readiness (6-9)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,344)

27

Self-Help Activities by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

94% 87%

68%

51%

Low Activity(0)

Moderate Activity(1-11)

High Activ-ity(12-19)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=8,342)

28

Strength Self-Efficacy Index by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%10% 8% 6% 8%

Low Strength(0-2)

Moderate Strength (3-6)

High Strength (7-10)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,766)

29

General Social Support Index by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 6% 5% 7% 10%

Low Support(0-1)

Moderate Support (2-4)

High Support(5-9)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=14,717)

30

Spiritual Social Support by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

62% 57%48%

28% Low Support (0-2)

Moderate Support (3-5)

High Support (6-7)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,476)

31

Environmental Strengths Index by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 5% 6% 11% 16%Low Strength(0-2)

Moderate Strength (3-5)

High Strength(12-16)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,625)

32

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

$11,000

$4,337 $4,725

$5,341

$6,525

$10,000+

$2,000 - $9,999

$0-$1,999

Mean

Quarterly Cost to Society* by Age

*Using 2011 Dollars

SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,690)

33

Problem Prevalence Index by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 6% 7% 10% 8%

High Preva-lence(25-100)

Moderate Prevalence (6-24)

Low Preva-lence(0-5)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,605)

34

Quality of Life by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

35% 37%25%

17%Low Quality (0-36)

Moderate Quality (37-69)

High Quality(70-100)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=22,126)

35

General Satisfaction by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%11% 10% 16%

26% Low Satis-faction(0-2)

Moderate Satisfaction(3-4)

High Satis-faction(5-6)

SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,281)

36

Program by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%ATM

ART

CYT

YORP

ORP

ATDC

SCY

AAFT

DC

EAT

TCE

Other

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,782)

37

Level of Care by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

77% 71% 71%

54%

10%11% 11%

37%

4% 8% 10%4%9% 9% 8% 5%1% 2%

STR

M-LTR

CC-OP

IOP

OP

SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,749)

38

Type of Treatment by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

47% 41%

24%14%

13%9%

11%20%

27%31%

37%

9%11% 24%

66%

5% 8% 4%

Tx Man

Other

ACRA/ACC

Other EBTx

MET/CBT

SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,880)

39

Outcomes The following slides present information on the outcomes of

substance abuse treatment by age, including: Abstinence Recovery GPRA outcomes (vocationally engaged, housed, no justice

system involvement, social consequences, abstinence, and social connectedness) and

NOMS outcomes (treatment initiation, engagement and continuing care; no problems with: health, mental health, family, illegal activity; abstinent, vocationally engaged and housed).

Data on follow up rates, months to last follow up, and number of follow ups per client are provided in the Methods Appendix.

40

Percent Change in 6 Month Abstinence by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

25% 20%15% 15%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,181)

41

Relative Percent Change in 6 Month Abstinence by Age

<15 15-17 18-25 26+0%

10%20%30%40%50%60%70%80%90%

100%

62%51%

32%24%

SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,181)

42

Past Month AOD Abstinence by Age

Intake 3 Month 6 Month 9 Month* 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<15

15-17

18-25

26+

*InterpolatedSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

43

Recovery* by Age

Intake 3 Month 6 Month 9 Month** 12 Month0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<15

15-17

18-25

26+

* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community.

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups **Interpolated

44In

take

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

Inta

ke

Las

t W

ave

0%10%20%30%40%50%60%70%80%90%

100%

Vocationally Engaged

Housing

No Justice Sys-tem Involvement

No Social Consequences

Abstinence

Socially Connected

Change in GPRA Outcomes by Age (Intake to Last Wave*)

<15 15-17 18-25 26+

*Last wave is the last follow-up

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

45

NOMS Outcome: Number of Treatment Received Outcomes Met* by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

33% 31% 35%

11%

39% 40% 39%

47%

None

One

Two

Three

Four

*Based on a count of initiation within 14 days, evidence based practice, engagement for at least 6 weeks, and any continuing care.

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=24,620)

46

SAMHSA Outcome: Treatment Cost Bands by Age

<15 15-17 18-25 26+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

55% 50%38%

28%

Above

Within

Below

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=17,856)

47

Change in Selected NOMS Outcomes by Age (Intake to Last Wave)

Inta

ke

Las

t...

Inta

ke

Las

t...

Inta

ke

Las

t...

Inta

ke

Las

t...

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%No Health Prob-lems

No Mental Health Problems

No Family Prob-lems

Abstinence

No Illegal Activ-ity

Vocationally Engaged*

Housed

<15 15-17 18-25 26+*Past monthSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups

48

NOMS Outcomes: Count of Positive Outcomes (Last FU–Intake) by Age

< 15 (77% w/ 1+)

15-17 (77% w/ 1+)

18-25 (78% w/ 1+)

26+ (76% w/ 1+)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

27% 29% 28% 22%

Less than nega-tive one

Negative one

None

One

Two

Three

Four

Five +

SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=25,508)