Chapter 11Subset of Overview by Mental Health Disorders
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
Past Year Pattern of Mental Health Disorders
Internalizing Disorders
Only 9.3%
(n=2,770)
Externalizing Disorders
Only 20.6%
(n=6,128)
Both 32.8%
(n=9,727)
Neither 37.3%
(n=11,059)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,684)
4
Risk and Protective Factors by Mental Health Disorders
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
Age by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12%2%
24%
8%
15%
7%
21%
13%
61%
72%
47%
66%
12%19%
8% 14%
<15
15-17
18-25
26+
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,684)
6
Gender by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
19% 17%
42% 39%
81% 83%
58% 61% Male
Female
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,673)
7
Race by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
22% 16% 15% 9%
31%
27% 31%26%
4%
3% 4%
4%
33%40% 37%
44%
11% 14% 14% 16%Multi-Racial
White
Other
Hispanic
African American
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,669)
8
8
Risk of Homelessness by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%20%30%40%50%60%70%80%90%
100%
80% 81%67% 67%
2% 2% 7% 7%Currently Homeless
At Risk of Homeless-ness
Group/Inst
Housed
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,549)
9
Past Year Substance Severity by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internalizing Disorders
Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
24%
46% 52%
74%
PY De-pendence
PY Abuse
PY Use
No PY Use
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,287)
10
Primary Substance by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internalizing Disorders
Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
29% 24% 29% 23%
55% 66%39% 51%
Other drug
Opioids
Amphetamines
Cocaine
Marijuana
Alcohol
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,630)
11
Neither Externaliz-ing Disor-ders Only
Internalizing Disorders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100% 9%18% 24%
44%High SU (6-8)
Moderate SU (3-5)
Low SU (0-2)
Number of Substance Problems by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,631)
12
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
29%38% 44% 48%
Dependence/Daily Use
Current PY Use
Past Use
Never Used
Tobacco Diagnosis by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,326)
13
HIV Risk Scale* by Mental Health Disorders
* Available at intake only.
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 5% 12%27%
40%High Risk(10-36)
Moderate Risk(3-9)
Low Risk(0-2)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,684)
14
HIV Risk Change Index* by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
InternalizingDisorders
Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 2% 6% 8% 18% HighRisk(4-7)
ModerateRisk(2-3)
LowRisk(0-1)
*Can be used to measure change.
SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,802)
15
Number of Sex Partners* by Mental Health Disorders
Neither Externaliz-ing Disor-ders Only
Internalizing Disorders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100%12% 18% 11% 19%
3+ Sex Partners
1-2 Sex Partners
No Sex Partners
*In the past 90 days
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,697)
16
Severity of Victimization by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%20%30%40%50%60%70%80%90%
100%
25%39%
59%71%
High Severity (4-15)
Moderate Severity (1-3)
Low Severity (0)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,455)
17
Neither Externaliz-ing Disor-
ders Only
Internaliz-ing Dis-orders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100% 4% 8%High Severity(4-5)
Moderate Severity (1-3)
Low Severity (0)
Homicidal/Suicidal Thoughts by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,424)
18
Health Problems by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 5% 7% 12% 14%High Problems(33-100)
Moderate Problems (10-32)
Low Prob-lems(0-9)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,414)
19
Health Care Utilization Cost* by Mental Health Disorders
*Using 2011 Dollars
Neither Externaliz-ing
DisordersOnly
InternalizingDisorders
Only
Both0%
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
$4,500
$5,000
$1,246
$1,688
$3,113
$4,393 $7,600+
$1-$7,599
$0
Mean
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,449)
20
Crime and Violence by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%14%
46%
21%
57%
High Crime(7-29)
Moderate Crime (3-6)
Low Crime(0-2)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,661)
21
Type of Crime by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internalizing Disorders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100%20%
49%
24%
54%
Violent Crime*
Other Crime**
Drug Use only
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,347)
* Violent crime includes assault, rape, murder, and arson.** Other crime includes vandalism, possession of stolen goods, forgery, and theft.
22
Cost of Crime* by Mental Health Disorders
*Using 2011 Dollars
Neither Externaliz-ing
DisordersOnly
InternalizingDisorders
Only
Both0%
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$1,000,000$1,100,000$1,200,000
$120,972
$457,291
$299,985
$1,117,770 $120,000+
$1-$119,000
$0
Mean
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,374)
23
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
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 activ-ity/SA use
Intensity of Justice System Involvement by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,574)
24
Count of Major Clinical Problems* at Intake by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internalizing Disorders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100% 4%
48% 49%
94%
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=29,684)
25
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%20%30%40%50%60%70%80%90%
100%17%
30%
52%65%
High Stress(3-15)
Moderate Stress(1-2)
Low Stress(0)
Sources of Stress Index by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,562)
26
Neither Externaliz-ing
Disorders Only
Internalizing Disorders
Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 5% 6% 4% 4%Low Readiness (0-2)
ModerateReadiness (3-5)
High Readiness (6-9)
Treatment Readiness by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,272)
27
Self-Help Activity by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
80% 81%65% 63%
Low Ac-tivity (0)
Moderate Activity (1-11)
High Ac-tivity (12-19)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=8,326)
28
Neither Externaliz-ing Disor-ders Only
Internaliz-ing Dis-orders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%8% 7% 7% 8%
Low Strength(0-2)
Moderate Strength (3-6)
High Strength (7-10)
Strength Self-Efficacy Index by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,737)
29
Neither Externalizing Disorders
Only
Internalizing Disorders
Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%10% 3% 7% 3%
Low Support(0-1)
Moderate Support (2-4)
High Support(5-9)
General Social Support Index by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=14,687)
30
Spiritual Social Support by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
48%59%
43%53%
Low Support (0-2)
Moderate Support (3-5)
High Support (6-7)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,446)
31
Neither Externaliz-ing Disor-ders Only
Internaliz-ing Dis-orders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%9% 5% 11% 7%
Low Strength(0-2)
Moderate Strength (3-5)
High Strength(12-16)
Environmental Strengths Index by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,580)
32
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
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
$3,330 $4,051
$5,607
$7,181
$10,000+
$2,000 - $9,999
$0-$1,999
Mean
Quarterly Cost to Society* by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=26,668)
*Using 2011 Dollars
33
Problem Prevalence Index by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 1% 4% 5%18% High Preva-
lence(25-100)
Moderate Prevalence (6-24)
Low Preva-lence(0-5)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=27,568)
34
Neither Externaliz-ing Disor-ders Only
Internaliz-ing Dis-orders Only
Both0%
10%20%30%40%50%60%70%80%90%
100% 4%
31%22%
72%
Low Quality (0-36)
Moderate Quality (37-69)
High Quality(70-100)
Quality of Life by Mental Health Disorders
SAMHSA 2011 GAIN Summary Analytic Data Set (n=22,096)
35
General Satisfaction by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internalizing Disorders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100%10% 8%
22% 22% Low Satis-faction(0-2)
Moderate Satisfaction(3-4)
High Satis-faction(5-6)
SAMHSA 2011 GAIN Summary Analytic Data Set (n=12,250)
36
Program by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%ATMARTCYTYORPORPATDCSCYAAFTDCEATTCEOther
SAMHSA 2011 GAIN Summary Analytic Data Set (n=29,684)
37
Level of Care by Mental Health Disorders
Neither Externaliz-ing Disor-ders Only
Internaliz-ing Dis-orders Only
Both0%
10%20%30%40%50%60%70%80%90%
100%
76% 73% 69% 63%
14%11% 16%
13%
6%7% 7%
9%
5% 8% 7%13%
STR
M-LTR
CC-OP
IOP
OP
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,651)
38
Type of Treatment by Mental Health Disorders
Neither Externaliz-ing
Disorders Only
Internaliz-ing
Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
41% 40%29% 32%
13% 10%
12% 9%
27% 30%
27% 29%
17% 13%28% 19%
3% 7% 4% 11%Tx Man
Other
ACRA/ACC
Other EBTx
MET/CBT
SAMHSA 2011 GAIN Summary Analytic Data Set (n=28,789)
39
Outcomes The following slides present information on the outcomes of
substance abuse treatment by mental health disorders, 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 Mental Health Disorders
Neither Externalizing Disorders Only
Internalizing Disorders Only
Both0%
10%20%30%40%50%60%70%80%90%
100%
20% 21%18% 20%
SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,135)
41
Relative Percent Change in 6 Month Abstinence by Mental Health Disorders
Neither Externalizing Disorders Only
Internalizing Disorders Only
Both0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
39%
57%
37%
54%
SAMHSA 2011 GAIN SA Data Set subset to 6 Month Follow up (n=20,135)
42
Past Month AOD Abstinence by Mental Health Disorders
Intake 3 Month 6 Month 9 Month* 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Neither
Externalizing Disorders Only
Internalizing Disorders Only
Both
*InterpolatedSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups
43
Recovery* by Mental Health Disorders
Intake 3 Month 6 Month 9 Month** 12 Month0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Neither
Externalizing Disorders Only
Internalizing Disorders Only
Both
* 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 Involve-ment
No Social Consequences
Abstinence
Socially Connected
Change in GPRA Outcomes by Mental Health Disorders (Intake to Last Wave*)
Neither Externalizing Disorders Only
BothInternalizing Disorders Only
*Last wave is the last follow-upSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups
45
NOMS Outcome: Number of Treatment Received Outcomes Met* by Mental Health Disorders
Neither Externalizing Disorders
Only
Internalizing Disorders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100%
32% 32% 28% 28%
40% 41% 40% 41%
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=24,564)
46
SAMHSA Outcome: Treatment Cost Bands by Mental Health Disorders
Neither Externalizing Disorders
Only
Internalizing Disorders
Only
Both0%
10%20%30%40%50%60%70%80%90%
100%
51% 51%40% 45%
Above
Within
Below
SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=17,822)
47
Change in Selected NOMS Outcomes by Mental Health Disorders (Intake to Last Wave)
Inta
ke
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%No Health Prob-lems
No Mental Health Problems
No Family Prob-lems
Abstinence
No Illegal Activ-ity
Vocationally Engaged*
Housed
Externalizing Only
Internalizing Only
Neither Both
*Past monthSAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups
48
NOMS Outcomes: Count of Positive Outcomes (Last FU–Intake) by Mental Health Disorders
Neither(69% w/ 1+)
Externalizing Disorders
Only(80% w/ 1+)
Internalizing Disorders
Only(77% w/ 1+)
Both(84% w/ 1+)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
17%31% 26%
38%
Less than negative one
Negative one
None
One
Two
Three
Four
Five +
SAMHSA 2011 GAIN SA Data Set subset to 1+ Follow ups (n=25,452)