Development and Evaluation of the Global Appraisal of Individual Needs Quick Version 4 (GAIN-Q4) for ASAM Dimension Ratings and Placement Recommendations for Adolescents and Adults.

Abstract

This article describes the development and evaluation of the Global Appraisal of Individual Needs Quick Version 4 (GAIN-Q4) for the American Society of Addiction Medicine (ASAM) 4th edition patient placement dimension ratings and level of care placement recommendations. The research questions are as follows: (1) Can the GAIN-Q4 replicate recommendations from the prior longer instrument within adolescents and adults? (2) What are the substantive differences in the results by age? The 35- to 45-minute GAIN-Q4 was developed through modification of the GAIN-Q3 and evaluated in terms of its ability to predict ASAM dimensional ratings and level of care placement recommendations from the 60- to 120-minute GAIN-I instrument. Data were obtained from participants who are adolescents aged 12 to 17 years (n = 101,897) and adults 18 years and older (n = 204,711) interviewed between 2002 and 2018 across 530 US sites. Reliability between measures was assessed with Cohen's κ statistic within age group; substantive differences by age were evaluated with logistic regression and χ 2 . The ability of the 35- to 45-minute GAIN-Q4 measure to predict ASAM 6 dimensional ratings from the 60- to 120-minute GAIN-I was excellent ( κ  > 0.8) for 4 dimensions, good (0.6-0.79) for 1, and fair for 1 (0.4-0.59) - both for adolescents and young adults. κ for general level of care placement to ASAM levels of care was excellent for both adolescents and young adults. The GAIN-Q4 demonstrates the ability to predict ASAM dimensional ratings and general level of care placement reliably when compared to the lengthier GAIN-I measure. These results highlight that clinicians using the GAIN-Q4 measure will be equipped to evaluate patients from a wide variety of sources with an accurate and reliable screening tool.