The measurement of outcome in alcohol and other drug treatment: a review of available instruments.

This technical report outlines the issues in measuring outcome in the alcohol and other drug field. It provides a review of the measures that are currently available. Introduction ♦ Outcome is defined as the effect on an individual’s health status that is attributable to an intervention. ♦ The potential clients are the 10% of the population who will meet criteria for an alcohol or other drug use disorder in the past 12 months. Only a third of the potential clients seek treatment in any year. Three quarters of those who seek treatment are seen by general practitioners. ♦ Outcome measurement is of importance to clients, clinicians and administrators. ♦ The standard measurement of outcome is likely to improve treatment. ♦ Outcome measures are reviewed in regard to their applicability, acceptability, practicality, reliability, validity and sensitivity to change. The advantages and disadvantages of self -report and clinician rated measures are discussed. ♦ Outcome measures are commonly cited in the literature. Measures that are brief, low in cost, multi-dimensional and require little training, are likely to be most suitable for use in routine clinical services. Methodology ♦ Consultation: A brief survey was conducted of 50 government and non- government alcohol and other drug treatment services ♦ Literature: A keyword search on Medline, Psych Info, Embase and Web of Science was conducted. Outcome measures were also identified from specialist texts and the citation lists of published treatment outcome studies in the alcohol and other drug field. Over 300 measures were examined as possible outcome measures. Of those, 44 were selected for examination and review by two independent raters. These measures include those designed for and used in adolescent populations. Results ♦ Consultation: Consultation with the field showed that ‘use of alcohol or other drugs’ and ‘functioning’ are viewed as the most important areas of outcome measurement. ‘Questionnaire’ or ‘interview with the client’ were rated as the preferred methods, and respondents stated that the collection of such data would improve service efficacy. ♦ Literature Review: The 44 measures reviewed covered the following areas: ‘screening of problematic use and quantity/frequency’, ‘diagnosis of dependence/harmful use’, ‘relapse’, ‘functioning’, ‘multi-dimensional’ and ‘satisfaction with service’.Measures were reviewed in regard to their applicability, acceptability, practicality, reliability, validity and sensitivity to change. Recommendations ♦ Four measures met minimum criteria for use as routine outcome measures: Addiction Severity Index (ASI), Health of the National Outcome Scale (HoNOS), Opiate Treatment Index (OTI) and Short Form-36 (SF-36). ♦ The Opiate Treatment Index is a measure developed in Australia and meets all the requirements. It is recommended that it be revised and shortened for use as a routine outcome assessment tool. Conclusion ♦ Outcome is important for clients, clinicians and managers. This report provides a review of instruments currently used to assess outcome in the alcohol and other drug field