# Presentation: 000318

## The Addiction Severity Index (ASI) Across Cultures

- 2005 NIDA International ForumJune 17th, 2005
- Workshop II - The Ireland Room B
- Thanks to NIDA:
- Steve Gust & Erin Winstanley

## The Addiction Severity Index (ASI) Across Cultures

- Today’s Presenters:

## Selection, Modification and Inter-rater Reliability on the use of the ASI in Egypt

Sample:  Adult Inpatient Hospital Program in Cairo

- Sample:  Adult Inpatient Hospital Program in Cairo

- Nasser Loza, Egypt_** **_

## Elaborating and using the ASI across different national realities and treatment conditions – The EuropASI in Greek Treatment Programmes

Sample: Adults in 6 Drug-Free Therapeutic Communities in Greece

- Sample: Adults in 6 Drug-Free Therapeutic Communities in Greece

- Gerasimos Papanastasatos, Greece_** **_

## Understanding the Israeli addict population – ASI profiles of former Soviet Union and native Israeli opiate abusers

Sample – Adults in detoxification, day treatment and methadone maintenance programs

- Sample – Adults in detoxification, day treatment and methadone maintenance programs

- Richard Isralowitz, Israel_** **_

## Incorporating the ASI: Exploring assessment and outcomes in a residential treatment facility in Northern Ireland

Sample:  Adult Residential Treatment Facility in Northern Ireland

- Sample:  Adult Residential Treatment Facility in Northern Ireland

- Debra Wilson & Pauline Murnin, Ireland

## The Brazilian experience on the implementation of the ASI – where are we right now?

Sample: Adult Cocaine Abusers @ HIV clinics in Brazil and a Validity Study of the ASI 6

- Sample: Adult Cocaine Abusers @ HIV clinics in Brazil and a Validity Study of the ASI 6

- Flavio Pechansky, Brazil

## Experiences using the ASI in different countries.

							and...

- 							and...

- Richard Rawson, USA

## ASI International Use and Data from 10 Countries

- Deni Carise, USA

## Introduction 

- <date/time>

- Introduction

- Introduction

- In addition to those presenting here, researchers and clinicians in the following countries have used the ASI:

- The ASI has been translated and modified for use in many countries.

## Countries

- <date/time>

- Introduction

- Thailand
- Scotland
- Hungary
- Ukraine
- The Netherlands
- Sweden
- Iran
- Pakistan
- Spain
- Italy

- Belgium
- Canada
- The Caribbean
- Chile
- Guatemala
- Morocco
- Tunisia
- Portugal
- Russia
- Norway

## Deni’s Presentation 

- <date/time>

- Introduction

- Deni’s Presentation

- Today, data are presented from the
- US Drug Evaluation Network System
- _and  various samples in:_
- 		Belgium	      Brazil
- 		Greece			Ireland
- 		Italy		       Norway
- 		Russia			Scotland
- 				Sweden

## Data Sets 

- Caution!
- No Comparisons!

## Data Sets 

- <date/time>

- Introduction

- Data Sets_** **_

- USA 	Deni Carise & A. Thomas McLellan
- 		8,479 patients from 14 inpatient/ 			residential, 4 methadone					maintenance and 18 out-patient 			treatment programs
- Brazil	Flavio Pechansky & Felix Kessler
- 		193 cocaine-dependent clients from
- 		3 HIV Clinics

## Data Sets 

- <date/time>

- Introduction

- Data Sets_** **_

- Greece	Gerasimos Papanastasatos & 			Erianna Daliani
- 		500 clients from 4 residential and
- 		2 OP programs
- Ireland 	Debra Wilson & Pauline Murnin
- 		162 clients from 1 inpatient 			program

## Data Sets 

- <date/time>

- Introduction

- Data Sets_** **_

- Belgium1		Joke De Wilde
- 			117 Clients from 4 adult 				residential drug-free TC’s
- Belgium2	 	Veerle Raes
- 			3,712 clients from a large 				drug addiction treatment				program

## Italy		Joke De Wilde
			101 clients from 5 adult residential 	
			drug-free TC’s

Norway 	Edle Ravndal
			482 clients from 10 IP, 4 MM, 3 				OP youth and 4 youth “collectives”.

Russia	Evgeny Krupitsky
			332 clients from 1 adult hospital 				detox & treatment program.

- 			101 clients from 5 adult residential
- 			drug-free TC’s
- Norway 	Edle Ravndal
- 			482 clients from 10 IP, 4 MM, 3 				OP youth and 4 youth “collectives”.
- Russia	Evgeny Krupitsky
- 			332 clients from 1 adult hospital 				detox & treatment program.

- Data Sets_** **_

## Scotland		Rowdy Yates
				134 clients from 1 adult OP drug			treatment program.

Sweden 		Jonas Larsson, David Oberg & 			Bjorn Sallmen
				201 prisoners from 16 SA 				prison-based treatment 					programs

- 				134 clients from 1 adult OP drug			treatment program.
- Sweden 		Jonas Larsson, David Oberg & 			Bjorn Sallmen
- 				201 prisoners from 16 SA 				prison-based treatment 					programs

- Data Sets_** **_

## Data Sets 

- Comparisons
- (Just for Fun)

## Data Presented:

- Gender
- Alcohol  & Drug Composite scores
- Days heavy drinking
- Days used marijuana
- Days used cocaine

## Data Presented:

- Composite Scores
- Days problems
- Days conflicts
- Percent reporting symptoms
- Illegal behavior
- Employment variables

## International Data

|  | Sample N | Age (SD) | % Male |
| --- | --- | --- | --- |
| Belgium1 | 117 | 24 (6) | 84 |
| Brazil | 193 | - | 89 |
| Greece | 500 | 26 (5) | 84 |
| Ireland | 162 | 41 (10) | 69 |
| Italy | 101 | 28 (4) | 88 |
| Norway | 482 | 31 (8) | 67 |
| Russia | 332 | 23 (0) | 74 |
| Scotland | 134 | 27 (6) | 68 |
| Sweden | 201 | 36 (11) | 95 |
| U.S.A. | 8429 | 35 (11) | 66 |

## International Data – Drug & Alcohol

|  | Alc. CS | Drink 5+ | Drg. CS | Cocaine | Cannabis |
| --- | --- | --- | --- | --- | --- |
| Belgium1 | .11 (.19) | 2 (5) | .17 (.13) | 1 (5) | 5 (8) |
| Brazil | .25 (.20) | 10 (9) | .19 (.10) | 13 (10) | 21 (11) |
| Greece | - | 0 (2) | .21 (.11) | 0 (2) | 2 (6) |
| Ireland | .67 (.26) | 16 (10) | .07 (.14) | 0 (1) | 3 (8) |
| Italy | .20 (.27) | 6 (11) | .26 (.17) | 2 (6) | 8 (12) |
| Norway | .08 (.14) | 2 (6) | .31 (.13) | 0 (3) | 10 (12) |
| Russia | .28 (.00) | - | .08 (.01) | - | - |
| Scotland | .07 (.18) | 4 (9) | .43 (.09) | 1 (4) | 16 (13) |
| Sweden | .52 (.28) | 13 (12) | .05 (.09) | 1 (4) | 2 (7) |
| U.S.A. | .21 (.26) | 3 (7) | .12 (.13) | 3 (7) | 2 (6) |

## International Data – Medical & Psychiatric

|  | Med. CS | Med. Prob. | Psy. CS | % Dep. | Psy. Prob. |
| --- | --- | --- | --- | --- | --- |
| Belgium1 | .35 (.32) | 10 (12) | .49 (.24) | 38 | 13 (12) |
| Brazil | .24 (.28) | 12 (9) | .23 (.22) | 21 | 15 (11) |
| Greece | .21 (.29) | 4 (8) | .21 (.18) | 21 | 9 (11) |
| Ireland | .40 (.41) | 11 (13) | .48 (.26) | 59 | 18 (13) |
| Italy | .17 (.23) | 2 (6) | .38 (.26) | 27 | 9 (12) |
| Norway | .25 (.32) | 8 (12) | .27 (.23) | 33 | 11 (13) |
| Russia | .23 (.01) | - | .25 (.01) | - | - |
| Scotland | .34 (.39) | 8 (5) | .32 (.26) | 64 | 11 (12) |
| Sweden | .34 (.37) | 10 (14) | .24 (.21) | 28 | 9 (13) |
| U.S.A. | .17 (.30) | 5 (10) | .19 (.23) | 30 | 8 (11) |

## International Data – Family & Legal

|  | Fam. CS | Conflicts | Leg. CS | Illegal Act | Work | Emp. Prob. |
| --- | --- | --- | --- | --- | --- | --- |
| Belgium1 | .20 (.22) | 2 (6) | .34 (.23) | 2 (7) | 2 (5) | 4 (8) |
| Brazil | .24 (.21) | 10 (10) | .12 (.17) | 8 (9) | 22 (9) | 9 (10) |
| Greece | .34 (.20) | 5 (9) | - | 1 (5) | 3 (8) | 5 (13) |
| Ireland | .29 (.26) | 7 (11) | .09 (.19) | 0 (3) | 4 (8) | 6 (11) |
| Italy | .36 (.26) | 7 (11) | .30 (.29) | 6 (10) | 4 (9) | 1 (1) |
| Norway | .16 (.19) | 4 (9) | .31 (.28) | 10 (13) | 5 (10) | 3 (9) |
| Russia | .41 (.01) | - | .17 (.02) | - | - | - |
| Scotland | .38 (.23) | 6 (8) | .40 (.25) | 17 (13) | 1 (5) | 9 (11) |
| Sweden | .18 (.20) | 3 (8) | .28 (.13) | 4 (10) | 5 (10) | 8 (13) |
| U.S.A. | .16 (.21) | 3 (7) | .18 (.21) | 1 (4) | 8 (10) | 8 (12) |

## Belgium2  	Veerle Raes
			Data collected 1998 - 2004
			3,712 interviews 
			383 Inpatient; 3,329 Outpatient
	All collected from a large “illegal drug addiction treatment program”  (may under-represent alcohol use).

- 			Data collected 1998 - 2004
- 			3,712 interviews
- 			383 Inpatient; 3,329 Outpatient
- 	All collected from a large “illegal drug addiction treatment program”  (may under-represent alcohol use).

- Larger Belgium Data Set_** **_

## USA vs. Belgium Data by Modality

|  | U.S.A. (IP) | Belgium2 (IP) | U.S.A. (OP) | Belgium2 (OP) |
| --- | --- | --- | --- | --- |
| Sample N | 3,133 | 383 | 3,885 | 3,329 |
| Age (SD) | 36 (11) | 25 (6) | 33 (10) | 27 (7) |
| % Male | 71 | 86 | 77 | 82 |
| Alc. CS | .33 (.27) | .1 (.2) | .16 (.23) | .1 (.1) |
| Drink 5+ | 5 (9) | 2 (5) | 2 (6) | 3 (6) |
| Drg. CS | .11 (.14) | .2 (.1) | .09 (.11) | .2 (.1) |
| Cocaine | 3 (8) | 2 (5) | 2 (6) | 2 (5) |
| Cannabis | 2 (6) | 4 (8) | 2 (6) | 11 (12) |

## USA vs. Belgium Data by Modality

|  | U.S.A. (IP) | Belgium2 (IP) | U.S.A. (OP) | Belgium2 (OP) |
| --- | --- | --- | --- | --- |
| Med. CS | .16 (.29) | .3 (.3) | .15 (.28) | .2 (.3) |
| Med. Prob. | 4 (9) | 8 (11) | 5 (10) | 7 (11) |
| Psy. CS | .20 (.24) | .3 (.2) | .16 (.22) | .2 (.2) |
| % Dep. | 31 | 34 | 25 | 30 |
| Psy. Prob. | 8 (12) | 14 (12) | 6 (11) | 10 (11) |
| Fam. CS | .15 (.21) | .3 (.2) | .13 (.20) | .1 (.2) |
| Conflicts | 3 (8) | 3 (8) | 2 (7) | 2 (6) |
| Leg. CS | .20 (.22) | .3 (.2) | .18 (.20) | .2 (.2) |
| Illegal Act | 1 (5) | 3 (7) | 1 (4) | 1 (5) |
| Work | 8 (10) | 1 (5) | 9 (11) | 8 (11) |
| Emp. Prob. | 8 (12) | 3 (8) | 9 (12) | 5 (10) |

##  Conclusions

- NONE

##  Conclusions

- Data presented just for discussion - No conclusions please!
- Data were collected from too many different locations (prisons, HIV clinics, in patient, outpatient treatment programs) and from too many different samples (opiate only users, primary alcohol users, an all inpatient sample, an outpatient only sample, etc.) for valid comparisons to be made.

##  Limitations

- LOTS

##  The End

- Thank You!