Richard D. Lennox

The impact of women's family status on completion of substance abuse treatment

This study examines the role of family status and demographic characteristics in explaining the nearly 60% dropout rate for women in substance abuse treatment. Data from the administrative record files of the Illinois Office of Alcoholism and Substance Abuse (OASA) for the fiscal year 1996–97 were analyzed for women age 12 or older who completed intake for publicly funded substance abuse treatment and whose outpatient treatment records were closed at year-end. Multivariate logistic regression models found that the likelihood of not completing treatment was greatest for women who were African American, pregnant, had custody of minor children, or were younger than age 21. However, African American women who had children in foster care were more likely to complete treatment. Implications for treatment and research are discussed.

Substance abuse and family illness: evidence from health care utilization and cost-offset research.

Although the substance abuse treatment community recognizes that physical and psychological problems are common among families with a substance-abusing member, third-party funding for comprehensive treatment of the families of substance abusers is limited. Failure to provide treatment for these collateral effects of substance abuse on the family is thought to reduce the efficacy of substance abuse treatment, increase the risk of relapse, and leave untreated secondary pathology among family members. This article presents a review of health care utilization and cost-offset studies of the collateral effects of substance abuse on the family to aid administrators and planners in documenting the economic advantages of comprehensive treatment for the families of substance abusers.

The Construct and Predictive Validity of Different Approaches to Combining Urine and Self-Reported Drug Use Measures among Older Adolescents after Substance Abuse Treatment

Reconciling urine results and self-reports is a classic challenge in substance abuse treatment research in general. For adolescents, the problems are compounded by the facts that they are more likely to use marijuana (which takes longer to metabolize) and to be coerced into treatment (which may increase lying). This article examines the construct and predictive validity of several different approaches for combining urine and self reported drug use including using common individual measures (urine tests and self-reported recency, frequency, and peak use), taking either as positive, using a summary scale, and using a latent model. Data are from 819 older adolescents 24 to 42 months after intake in seven sites. Days of use, the GAINs substance frequency scale, and a latent model were the three best methods in terms of construct and predictive validity. Implications for treatment and longitudinal evaluation will be discussed.

The cost of depression-complicated alcoholism: health-care utilization and treatment effectiveness.

Clinical and epidemiologic evidence suggests that alcoholism complicated by concurrent or a lifetime history of depression is slower to remit and more prone to relapse than uncomplicated alcoholism. Consequently, alcoholics with a history of depressive illness, on average, are likely to use more health care and to have higher treatment costs than those without depression complications. This article contrasts evidence of the suitability of three models for predicting the impact of depression on an alcoholic’s health-care use: a null model (assuming no differences) a cumulative-effect model (arguing for a linear increase associated with comorbid depression), and a synergistic model (wherein alcoholism complicated with depression is qualitatively as well as quantitatively different than uncomplicated alcoholism). To test these models, health-care costs and utilization of 491 “pure” alcoholics (those with no history of depression diagnosis) and 199 depression-complicated alcoholics, who received alcohol treatment while enrolled in a self-insured health-care program of a major U.S. manufacturing company, were compared. Results are discussed in terms of the implications for cost containment and the likelihood of relapse among the depression-complicated alcoholism group.

Measurement Error Issues in Substance Abuse Services Research: Lessons from Structural Equation Modeling and Psychometric Theory.

Evaluating the effectiveness of treatment for long-term chronic conditions requires more sensitive measures of quality of life and daily functioning than those treatments for acute care. Unfortunately, most of these measures require some degree of subjective reports and are affected by a number of systematic and unsystematic measurement errors that typically increase the probability of incorrectly declaring the treatment ineffective or indicative of a Type II error. These include method effects, such as social desirability or acquiescence, and structural errors that occur when the items reliably measure something other than what they were intended to measure. This paper explores some potential methods for removing or otherwise controlling random measurement error, assessment artifacts, irrelevant variation in outcome measures, and confounding sources of covariation in a structural equations paradigm. Using examples with some popular measures of quality of life and functioning, the paper also looks at the appropriateness of their use in observational, quasi-, and randomized field experiments.

Development and Validation of Short Versions of the Internal Mental Distress and Behavior Complexity Scales in the Global Appraisal of Individual Needs (GAIN)

Co-occurring mental distress and behavior problems are the norm in substance abuse treatment but are often poorly assessed due to resource constraints. This paper describes the development and validation of scales measuring internalizing mental distress and externalizing behavior problems that are shorter versions of comorbidity scales found in the full Global Appraisal of Individual Needs (GAIN). GAIN data from two treatment outcome studies, one involving adolescents and the other on adults, were used in the creation and testing of the scales. Subsets of items from the full GAIN scales were selected for the short scales through the application of standard psychometric principles. The short comorbidity scales still have moderate to high reliability and are highly correlated with the full scales. Parallel tests of construct validity show no substantial loss when moving from the longer to shorter versions. The short scales maintain good sensitivity and specificity for predicting diagnostic impressions.

A latent variable model of evidence-based quality improvement for substance abuse treatment

Attempts to improve the quality of substance abuse treatment are hampered by an inability to define specifically the elements of high quality of care and, more important, the lack of a research paradigm within which to study the necessary and sufficient elements of appropriate care. This study proposes that the quality-of-care (QOC) construct for substance abuse treatment might be best considered as a latent construct that does not necessarily exist as a single set of criteria but instead is indicated by a set of empirically derived indicators manifested as a latent factor. Results support defining latent QOC variables across levels of care for alcoholism treatment and empirically defining latent QOC measures from administrative records.

Comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) in Predicting the Effectiveness of Drug Treatment Programs for Pregnant and Postpartum Women

This study conducts a within-subject comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) to assess change in alcohol and other drug treatment outcomes for pregnant and postpartum women. Data are from 139 women who were pregnant or who had children under 11 months old and were admitted to residential drug treatment, then re-interviewed 6 months postdischarge (83% follow-up rate). The ASI and GAIN change measures were compared on their ability to detect changes in alcohol and drug use, medical and HIV risk issues, employment issues, legal problems, family and recovery environment characteristics, and psychological/emotional issues. The measures were similar in their ability to detect treatment outcomes, and ASI and GAIN change scores were moderately correlated with each other. The GAIN scales had equal or slightly higher coefficient alpha values than the ASI composite scores. The GAIN also includes an HIV risk scale, which is particularly important for pregnant and postpartum women. These results suggest that the GAIN is comparable with the ASI and can be used for treatment research with pregnant and postpartum women.

Analyzing shelter organizations and the services they offer: Testing a structural model using a sample of shelter programs

Abstract Although the need for services for homeless people, including health, substance abuse, and mental health treatment, has been widely documented, very little attention has been paid to the structural demands on shelter organizations that deliver these services. The present paper presents an exploratory study of 192 shelters in 29 cities that provide overnight accommodation to individuals and families using structural equation analysis to analyze the characteristics of the organizational and service delivery system. The resulting model suggests that services and amenities offered within the sample of shelter organizations are best understood as being influenced by organizational structure, as measured by occupational specialization, mediated through the organizations relationship with the external actors. This preliminary model offers researchers, policy makers and program planners a tool for analyzing the organizational needs that are necessary to support different services and amenities.