Thesis (Ph. D.)--West Virginia University, 2005. / Title from document title page. Document formatted into pages; contains ix, 122 p. Includes abstract. Includes bibliographical references (p. 98-114).

<p>Ett problem som många människor lever med i dagens samhälle är missbruk av alkohol eller droger. Inom socialtjänsten i Sverige används olika bedömningsmetoder för att fastställa klienters problem och hjälpbehov. En av dessa metoder är Addiction Severity Index (ASI) som rekommenderas av Socialstyrelsen i Nationella riktlinjer för missbruks- och beroendevården och som är en del i en överenskommelse i RIM-projektet i Uppsala län. Tidigare studier har visat att socialarbetare har en positiv attityd till ASI men trots det används metoden inte fullt ut eller i så stor utsträckning som kan förväntas.Syftet i föreliggande uppsats var att undersöka hur personal inom socialtjänsten implementerade ASI, det vill säga hur de använde och värderade metoden i verksamheten. Studiedesign var fallstudie i vilken intervjuer utfördes med 10 socialsekreterare i Enköping och Uppsala. Analysen utgick ifrån analysmodellen kan, förstår, vill och de huvudkategorier som lyftes fram med hjälp av denna var Hur – socialsekreterarnas användning av ASI, Kan – åtgärder för användning av ASI, Förstår – socialsekreterarnas förståelse för ASI, Vill – socialsekreterarnas vilja att använda ASI.Studien visade att socialsekreterarna använde ASI i utredningsarbetet. I verksamheten vidtogs det åtgärder för att socialsekreterarna skulle kunna använda ASI. De hade kunskaper både om varför och hur de skulle använda metoden, de hade tillgång till olika resurser och tycktes vilja använda metoden. Trots den positiva inställning som socialsekreterarna tycktes ha till ASI implementerade de inte metoden enligt uppsatta mål.</p>

Ett problem som många människor lever med i dagens samhälle är missbruk av alkohol eller droger. Inom socialtjänsten i Sverige används olika bedömningsmetoder för att fastställa klienters problem och hjälpbehov. En av dessa metoder är Addiction Severity Index (ASI) som rekommenderas av Socialstyrelsen i Nationella riktlinjer för missbruks- och beroendevården och som är en del i en överenskommelse i RIM-projektet i Uppsala län. Tidigare studier har visat att socialarbetare har en positiv attityd till ASI men trots det används metoden inte fullt ut eller i så stor utsträckning som kan förväntas.Syftet i föreliggande uppsats var att undersöka hur personal inom socialtjänsten implementerade ASI, det vill säga hur de använde och värderade metoden i verksamheten. Studiedesign var fallstudie i vilken intervjuer utfördes med 10 socialsekreterare i Enköping och Uppsala. Analysen utgick ifrån analysmodellen kan, förstår, vill och de huvudkategorier som lyftes fram med hjälp av denna var Hur – socialsekreterarnas användning av ASI, Kan – åtgärder för användning av ASI, Förstår – socialsekreterarnas förståelse för ASI, Vill – socialsekreterarnas vilja att använda ASI.Studien visade att socialsekreterarna använde ASI i utredningsarbetet. I verksamheten vidtogs det åtgärder för att socialsekreterarna skulle kunna använda ASI. De hade kunskaper både om varför och hur de skulle använda metoden, de hade tillgång till olika resurser och tycktes vilja använda metoden. Trots den positiva inställning som socialsekreterarna tycktes ha till ASI implementerade de inte metoden enligt uppsatta mål.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-02-26T17:50:54Z No. of bitstreams: 1 lidiareisfernandes.pdf: 1602073 bytes, checksum: b27488da269ddab42a8bc991fe994695 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-03-03T14:08:36Z (GMT) No. of bitstreams: 1 lidiareisfernandes.pdf: 1602073 bytes, checksum: b27488da269ddab42a8bc991fe994695 (MD5) / Made available in DSpace on 2016-03-03T14:08:36Z (GMT). No. of bitstreams: 1 lidiareisfernandes.pdf: 1602073 bytes, checksum: b27488da269ddab42a8bc991fe994695 (MD5) Previous issue date: 2015-02-03 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: O uso abusivo ou dependência de substâncias psicoativas pela população brasileira constitui problema relevante no âmbito da saúde pública. A disponibilização de um instrumento que avalie o quadro geral de um usuário de álcool e outras drogas é útil para o planejamento do tratamento e para avaliação de sua efetividade. O Addiction Severity Index (ASI) é um instrumento que permite avaliar informações sobre vários aspectos da vida de pessoas com problemas associados ao uso de álcool e outras drogas, como problemas médicos, no emprego, nos aspectos legais, sociofamiliares, psiquiátricos, além do uso de álcool e de outras drogas. Sua sexta versão foi validada para o Brasil obtendo boas propriedades psicométricas, porém faz-se necessário o desenvolvimento de uma versão brasileira reduzida do ASI6 para otimizar o tempo de aplicação. Objetivo: O presente trabalho buscou desenvolver e avaliar as Propriedades Psicométricas de uma versão brasileira reduzida do ASI6, proposta a partir de um estudo de validação dos construtos do instrumento. Método: Foram entrevistados 200 sujeitos, 100 com uso problemático de álcool e outras drogas e 100 sem uso problemático. Foram calculados os escores dos indivíduos a partir da Teoria de Resposta ao Item. As propriedades psicométricas foram avaliadas pela correlação entre os escores do ASI6 e do ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), padrão-ouro do estudo. Foram avaliados os índices de sensibilidade e especificidade. Resultados: Foi encontrada uma alta correlação entre o escore da área “álcool” do ASI 6 Light e os escores do ASSIST em relação ao álcool (r=0,79), correlações moderadas em relação ao tabaco (r=0,47) e cocaína/crack (r=0,44) e baixa (r=0,39) em relação à maconha. Ao correlacionar os escores do ASSIST e os escores da área drogas do ASI 6 Light obteve-se uma alta correlação em relação à cocaína/crack (r=0,85), correlações moderadas em relação ao tabaco (r=0,57) e maconha (r=0,68) e baixa (r=0,29) em relação ao álcool. A área sob a curva ROC da área “álcool” foi 0,93 e da área “drogas” foi 0,88. Discussão: Com este estudo foi possível desenvolver e avaliar as propriedades psicométricas da versão reduzida do ASI6 Light. Boas evidências de validade da área “álcool” e “drogas” foram apresentadas. Essa nova versão tornou-se um instrumento de fácil manejo e de rápida aplicação, contendo os itens que melhor avaliam a gravidade de problemas com substâncias e dos problemas associados nas diversas áreas. / Introduction: The abuse or dependence on psychoactive substances by the Brazilian population is a relevant problem in public health. The availability of an instrument to assess the general framework of a user of alcohol and other drugs is useful for treatment planning and to evaluate their effectiveness. The Addiction Severity Index (ASI) is an instrument to evaluate information on various aspects of life of people with problems associated with alcohol and other drugs such as medical conditions, on employment, legal, social-familial, psychiatric, and the use alcohol and other drugs. His sixth version was validated in Brazil getting good psychometric properties, but it is necessary the development of a shortened Brazilian version of the ASI6 to optimize the exposure time. Aims: This study aimed to develop and evaluate the Psychometric Properties of a shortened Brazilian version of the ASI6, proposal from a validation study of the instrument constructs. Method: 200 subjects were interviewed, 100 with the abuse of alcohol and other drugs and 100 without problematic use. The scores of individuals from the Item Response Theory were calculated. The psychometric properties were evaluated by the correlation between the scores of the ASI6 and ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), the gold standard study. We assessed the sensitivity and specificity rates. Results: A high correlation between the score of the area "alcohol" ASI6 Light and scores ASSIST regarding alcohol was found (r = 0.79), moderate correlations with tobacco (r = 0.47) and cocaine / crack (r = 0.44) and low (r = 0.39) with respect to marijuana. Correlating ASSIST scores and the scores of the area of drugs ASI6 Light obtained a high correlation to cocaine / crack (r = 0.85), moderate correlations with tobacco (r = 0.57) and marijuana (r = 0.68) and low (r = 0.29) compared to alcohol. The area under the ROC curve of area "alcohol" was 0.93 and the area "drugs" was 0.88. Discussion: With this study was possible to develop and evaluate the psychometric properties of the short version of the ASI6 Light. Good evidence of validity of the area "alcohol" and "drugs" were presented. This new version has become an instrument for easy handling and quick application, containing the items that best assess the severity of problems with substances and the problems associated in various areas.

Sammanfattning Titel: ’’Det är ju ett våldsamt liv, att vara missbrukare’’- Socialsekreterares syn på ASI- intervjuns användbarhet beträffande våld i nära relationer  Författare: Isabell Eklöf och Mimmi Wallin Nilsson  Syftet med studien var att undersöka hur socialsekreterare inom alkohol-och drogmissbruksområdet uppfattar ASI-intervjuns användbarhet att identifiera våld i nära relation samt stödja våldsutsatta och våldsutövare. Data samlades in genom fem semistrukturerade intervjuer med socialsekreterare inom alkohol- och drogmissbrukområdet med erfarenhet av ASI i Sverige. Resultatet analyserades med hjälp av tidigare forskning och begreppen handlingsutrymme samt relationskompetens, yrkeskompetens och handlingskompetens. Resultatet visar att ASI-intervjun är ett bra verktyg för att screena våld i nära relation men inte för att stödja våldsutövare och våldsutsatta. Flertalet faktorer påverkar ASI-intervjuns användbarhet; bland annat klienternas komplexa problematik, relationen mellan socialsekreterare och klient, samt socialsekreterarens intresse att ställa följdfrågor. Troligtvis hade ASI-intervjun varit mer användbar om frågornas utformning justerats. En slutsats är att det är upp till den enskilde socialsekreteraren och dess handlingsutrymme hur användbar ASI-intervjun är. / Abstract Title: ”It is a violent life to be an addict” - Social workers' views on the usefulness of the  ASI interview regarding violence in intimate relationships.  Authors: Isabell Eklöf and Mimmi Wallin Nilsson  The purpose of the study was to investigate how social workers in the alcohol and drug abuse field perceive the ASI interview’s usefulness to identify violence in intimate relationships and support victims and perpetrators. Data were collected through five semi- structured interviews with social workers in the alcohol and drug abuse field with experience of ASI in Sweden. The result was analyzed with previous research, the concept room for maneuver, relational competence, professional competence and action competence. The results showed that ASI is useful for screening violence in intimate relationships, but not for supporting perpetrators and victims. The social workers' interest in asking follow-up questions, clients' complex problems and the relationship between social worker and client are examples of what affects the ASI' usefulness. ASI could be more useful if the questions were adjusted. One conclusion is that the individual social worker and their room for maneuver determines the ASI’s usefulness.

Addiction Severity Index (ASI) är tänkt att användas både för klientarbete på individnivå och för forskning på gruppnivå. Denna studie undersöker i vilken omfattning ASI-Uppföljning genomförs samt vilka individ- och organisationsfaktorer som påverkar användningen. Studien är kvantitativ dvs presenterar statistiska analyser. Data samlades in på två sätt. Tillgång till ASI-data gjordes möjlig genom en avidentifierad fil från databasen ASI-Net och omfattade data från elva kommuner i Jönköpings län. ASI-data bestod av 1964 intervjuer från ASI-Grund och ASI-Uppföljning och behövdes för undersökningen av individfaktorerna. Data angående organisationsfaktorerna samlades in genom webbenkäter till cheferna inom Individ- och Familjeomsorg (IFO) i samma elva kommuner. Resultatet visar att andelen uppföljningsintervjuer ökar för varje år och att det föreligger stora skillnader mellan kommuner i genomförande av andelen uppföljningsintervjuer. Analysen av individfaktorerna tyder på att de äldre, med högre utbildning och ett yrke återintervjuas i högre utsträckning. Klienterna med stora problem och hjälpbehov med alkohol genomgår i högre grad en uppföljningsintervju, medan mer problem med narkotika och rättsliga problem tenderar att följas upp i mindre grad. Analysen av organisationsfaktorerna kunde ej på meningsfullt sätt signifikansprövas då populationen för webbenkäten var liten. Dock upptäcktes korrelation mellan andelen uppföljningsintervjuer för varje kommun och två organisationsfaktorer, befolkningsmängd i kommunerna samt personalomsättning. Organisationsfaktorerna visar tvärtemot förväntat att små kommuner följer upp en högre andel, och att faktorer som personalomsättning, utbildning och ärendemängd inte förklarar de skillnader som finns.  Studiens slutsats visar att andelen genomförda ASI-Uppföljning ökar kontinuerligt. Även om ASI-Uppföljning ökar så är det långt kvar till dess att ens hälften av alla ärenden med ASI-Grund återintervjuas. För att öka motivationen att genomföra uppföljningsintervjuer kan det vara viktigt att socialsekreterarna får mer tillbaka i form av sammanställningar och analyser på gruppnivå. / Addiction Severity Index (ASI) is thought to be used both for client work at the individual level and for research at a group level. This study examines the extent to which the ASI Follow-up is carried out, and the individual and organizational factors influencing the usage. The study is quantitative, i.e. presents statistical analyzes. Data were collected in two ways. Access to ASI data was made possible by an anonymous file from the database ASI-Net and included data from eleven municipalities in Jönköping County. ASI data consisted of 1,964 interviews from ASI Basic and ASI Follow-up and was needed for the investigation of individual factors. Data regarding organizational factors was collected through web surveys to managers in Individual and Family Care (IFO) in the same eleven municipalities. The result shows that the percentage of follow-up interviews is increasing every year and that there are large differences between municipalities in the usage of the percentage of follow-up interviews. The analysis of individual factors suggest that the elderly, with higher education and a profession are interviewed to a greater extent. Clients with serious problems and in need of help with alcohol also undergo follow-up interviews more frequently, while more problems with drugs and legal problems tend to be followed-up to a lesser degree. The analysis of organizational factors could not in a meaningful way be tested for significance since the population for the web survey was small, however, correlation was discovered between the percentage of follow-up interviews for each municipality and organizational factors of population in municipalities and employee turnover. Organizational factors show the contrary as expected that small municipalities follow up to higher degree, and that factors such as staff turnover, training and case quantity does not explain the existing differences. The study's conclusions are that the percentage of ASI Follow-up is continuously increasing. Although the ASI follow-up is increasing, it is a long way until the even half of all cases with ASI Basic are re-interviewed. To increase the motivation to carry out follow-up interviews, it may be important for the social workers to get back more in the form of summaries and analyzes at the group level.

Pour appréhender l'ensemble du problème addictif et proposer une prise en charge appropriée, une évaluation multifactorielle est nécessaire. Les données récentes soulignent que le champ des addictions aux substances doit être étendu au champ des addictions comportementales. Une des lacunes dans la compréhension des troubles addictifs et de leur prise en charge pourrait être due à un manque d'outils d'évaluation standardisés qui évaluent l'ensemble des composantes de l'addiction et leurs répercussions dans différents domaines de la vie du sujet. Dans le champ des addictions aux substances, l'Addiction Severity Index (ASI) est l'outil le plus utilisé mondialement. L'ASI est un instrument qui évaluent les sujets pour la clinique ou la recherche. En France, notre groupe de recherche utilise l'ASI depuis 1992 pour la clinique et la recherche. Nous avons décidé de modifier l'ASI en y ajoutant de nouvelles sections. Depuis 2006, la version française modifiée de l'ASI présente donc des items évaluant l'usage de tabac (Section Tabac) et également des items permettant l'évaluation des comportements addictifs sans substance comme le jeu, le jeu d'argent et de hasard et les troubles du comportement alimentaire. L'objectif général de cette thèse était d'étudier la validité de la version française modifiée de l'Addiction Severity Index (ASI) chez des sujets pris en charge pour au moins une addiction dans des centres de soins spécialisés en addictologie. Les résultats montraient une très bonne validité des données de consommations de substances rapportées par les sujets. Les sections Tabac et Jeu / Jeu d'argent et de hasard avaient été montrées comme valides. La version modifiée de l'ASI semble être un bon outil permettant l'évaluation de la sévérité de l'ensemble des comportements addictifs. Cette adaptation fait de l'ASI modifié le premier outil qui permet d'évaluer l'ensemble des troubles addictifs et qui ne mesure pas uniquement la quantité, la durée et l'intensité de ces troubles. Elle va permettre d'aider le clinicien à mettre en place une prise en charge la plus adaptée et aux chercheurs de caractériser et de comparer les différentes addictions afin de dégager des différences et des similitudes. / A multidimensional assessment is key to understand the addiction problem and to develop an appropriate treatment plan. Recent findings support the scope that addictive disorders should include non-substance use disorders. A significant problem in understanding and managing the addictive disorders may be related to the lack of standardized instruments for assessing problems or other aspects of life that are affected by these pathologies. For the assessment of substance users exists a widely used instrument, the Addiction Severity Index (ASI). The ASI is an instrument that assesses subjects for both clinical and research purposes. In France, our research group used the ASI since 1992 for both clinical and research purposes. We decided to modify the French translation of the ASI and added some new items. Since 2006, the French modified ASI includes items to assess tobacco use but also non-substance addictive behaviors including gaming, gambling and eating disorders. The overall objective of this dissertation was to assess the validity of the French modified ASI in several samples of clients who sought treatment in outpatient addiction clinics. The findings showed a good validity of the self-reported substance use. The validity of the Tobacco section as well as the Gaming/Gambling section have been shown. The French modified ASI is a suitable instrument for assessing any type of addiction-related disorders. This adaptation makes the modified ASI the first instrument that assesses all possible addictive behaviors regardless of the type of the addiction and that measures more than just the quantity, duration, and intensity of addictive behaviors. ASI may be helpful for clinicians in helping them to design the best treatment plans for a patient, for policy makers to objectively understand the need in treatment, care centers or other institutions but also for researchers to measure contemporary issues in addiction treatment and to find similarities and differences between type of addiction.

Evidensbaserad praktik inom socialtjänsten förutsätter att de professionella ställer sig positiva till forskningsbaserad kunskap om insatser och användandet av bedömningsinstrument. I vår studie undersöks vilken tilltro socialarbetare på vuxenenheten i en mindre stad har till bedömningsinstrumentet Addiction Severity Index (ASI). Studien är en kvalitativ undersökning och semistrukturerade intervjuer valdes som metod för att besvara syfte och frågeställningarna. Sammanlagt har sex respondenter intervjuats varav fyra handläggare, en projektledare samt enhetschefen på verksamheten. Forskning visar att handläggare upplever olika fördelar och nackdelar i användandet av ASI. Av resultatet framgår att handläggarna använder ASI Grund regelbundet i sitt arbete men att det finns svårigheter med att implementera ASI Uppföljning. Samtliga handläggare upplever att ASI Grund är tidskrävande och har en del invändningar mot vissa av frågorna. Trots detta uttrycker de ändå att användandet av ASI kan bidra till ett rättsäkerhetsperspektiv, ett strukturerat arbetssätt och en bra grund inför behandlingsplaneringen. I studien diskuteras även förbättringsområden inom ASI. / Evidence-based practice in social services presupposes that the professionals are in favor of research-based knowledge on services an the use of assessment instruments. The purpose of this study is to examining the confidence of social workers in an adult unit, in a small town has to assess the instrument Addiction Severity Index (ASI). The study is a qualitative survey ans semi-structured interviews were chosen as a method to answer the purpose and research questions. A total of six respondents were interviewed; four social workers, one project manager and the head of unit in operation. Research shows that social workers experience different advantages and disadvantages in the use of ASI. The results show that social workers use the ASI on a regular basis in their work, but there are difficulties in implementing the ASI follow-up interview. All social workers feel that the ASI base interview is time consuming and has concerns with some of the questions. Nevertheless, they express that the use of the ASI can contribute to a legal security perspective, a structured approach and a good basis for treatment planning. The study also discusses areas for improvement in the ASI.

The purpose of this paper was to examine how clients on the unit for adults at Södemalms district administration (Stockholm, Sweden) with severe mental illness and substance abuse differs from other clients with substance abuse at the baseline and at follow-up one year later. We have used a quantitative method and analyzed material from ASI-interviews performed at the adult drug abuse unit at Södermalm during the time period 2002-2010. At the baseline the clients with substance abuse and co-occurring severe mental illness have more problems than other clients, primarily in the area of mental health. They spend more time alone and are more likely to engage in illegal activities. Interviewers assess their situation as more serious and that they need more help in all of ASI's areas of life than other clients. Persons with severe mental illness have improved during the follow-up. However, the numbers of homeless people have increased and fewer have jobs. Meanwhile, more people have a regular income from the social security, their somatic status has improved, fewer hang out with people who have an active addiction, they engaged not so much in crime. Furthermore, the proportion of heavy use alcohol and narcotics has declined. Mental health improved significantly. The proportion meeting the threshold of severe mental disorder is reduced from 47% to 29%. The risk of suicide attempts in the last month reduced from 5% to 1%.

The aim of this dissertation is to examine the implementation of the Addiction Severity Index (ASI) in social services and how it affects the encounter between the clients and their social workers. As structured interviews are unusual in social service based addiction care there is concern that they will have negative consequences on the relation between the social workers and their clients. The first study therefore investigates the clients’ acceptance of the ASI. The results show that 95 % of the clients accepted the ASI and that 85% viewed it in positive terms. Approximately 8% reported feeling violated by one question without this having any negative effect on the relation to the social workers or confidence in the social services. The results did not give empirical support for negative effects of the ASI. In the second study a comparison was made between a group that had participated in an assessment session using the ASI and a group with which the ASI had not been used. The results show that there is no difference in perception of “the alliance” or “negative experiences” with or without the ASI, but that the clients’ feeling of “own competence” is lower when the ASI is employed. The question of whether the reduced feeling of own competence among the clients is an expression of greater realism and reduced denial or only the negative effect of increased helplessness on the clients’ self-esteem can not be resolved in this study. In the third study, based on the same groups participating in the second study, the social workers were also asked to judge how the clients experienced such assessment sessions. The results show that the social workers’ assessment of the clients’ experiences differed from the clients’ own experiences regarding the “alliance” and “clients’ own feelings of competence”. However, the social workers made a correct assessment of the clients’ “negative experiences” of the sessions. The two different forms of session, with or without the ASI, did not influence the social workers’ assessment of the clients’ perceptions. The fourth study presents the results of a national questionnaire completed by 555 members of staff in social services, the prison service, and addiction services. The results show that supervisors and bosses take an increasingly greater responsibility for ASI training and that opportunities for using the ASI varied according to the place of work. Differences can probably be explained by different services being in different phases of implementation at the time of the study. The ASI has primarily been used in direct client work and only to a minor extent for follow-ups and evaluation. The number of ASI interviews carried out is small especially for those trained prior to 1999.