The Addiction Severity Index (ASI) Across Cultures

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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
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The Addiction Severity Index (ASI) Across Cultures
Todays Presenters
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Nasser Loza, Egypt

• Selection, Modification and Inter-rater
  Reliability on the use of the ASI in Egypt
• Sample Adult Inpatient Hospital Program in Cairo

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Gerasimos Papanastasatos, Greece

• 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

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Richard Isralowitz, Israel

• 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

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Debra Wilson Pauline Murnin, Ireland

• Incorporating the ASI Exploring assessment and
  outcomes in a residential treatment facility in
  Northern Ireland
• Sample Adult Residential Treatment Facility in
  Northern Ireland

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Flavio Pechansky, Brazil

• The Brazilian experience on the implementation of
  the ASI where are we right now?
• Sample Adult Cocaine Abusers _at_ HIV clinics in
  Brazil and a Validity Study of the ASI 6

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Richard Rawson, USA

• Experiences using the ASI in different countries.
• and

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Deni Carise, USA

• ASI International Use and Data from 10 Countries

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Introduction
Introduction
The ASI has been translated and modified for use
in many countries.
In addition to those presenting here, researchers
and clinicians in the following countries have
used the ASI
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Countries
Introduction
Thailand Scotland Hungary Ukraine The
Netherlands Sweden Iran Pakistan Spain Italy
Belgium Canada The Caribbean Chile Guatemala
Morocco Tunisia Portugal Russia Norway
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Denis Presentation
Introduction
Today, data are presented from the US Drug
Evaluation Network System and various samples
in Belgium Brazil Greece Ireland It
aly Norway Russia Scotland Sweden
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Data Sets
Caution! No Comparisons!
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Data Sets
Introduction
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

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Data Sets
Introduction
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

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Data Sets
Introduction
Belgium1 Joke De Wilde 117 Clients from 4
adult residential drug-free TCs Belgium2
Veerle Raes 3,712 clients from a large
drug addiction treatment program

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Data Sets

• Italy Joke De Wilde
• 101 clients from 5 adult residential
• drug-free TCs
• 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.

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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

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Data Sets
Comparisons (Just for Fun)
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Data Presented

• Age
• Gender
• Alcohol Drug Composite scores
• Days heavy drinking
• Days used marijuana
• Days used cocaine

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Data Presented

• Medical, Psychiatric, Family and Legal
• Composite Scores
• Days problems
• Days conflicts
• Percent reporting symptoms
• Illegal behavior
• Employment variables

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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
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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)
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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)
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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)
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Larger Belgium Data Set

• 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).

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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)
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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)
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Conclusions
NONE
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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.
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Limitations
LOTS
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The End
Thank You!