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Chapter 20 Briefing Slides Summary

Chapter 20 Briefing Slides Summary. GAIN Coordinating Center (11/21/2012). Normal , IL: Chestnut Health Systems. November 2012 . Available from www.gaincc.org/slides.

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Chapter 20 Briefing Slides Summary

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  1. Chapter 20Briefing Slides Summary GAIN Coordinating Center (11/21/2012). Normal, IL: Chestnut Health Systems. November 2012. Available from www.gaincc.org/slides Created for: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) under contract number 270-2012-00001

  2. This report presents information from the 2011 SAMSHA/CSAT GAIN Outcome Data set, including data on 29,782 clients from 230 local evaluations recruited between 1997 and 2011. Data was collected using the Global Appraisal of Individual Needs (GAIN) with clients admitted for substance abuse treatment. Eighty-nine percent of clients had one or more follow-ups at 3, 6, 9, and 12 months. The following slides summarize highlights from Chapters 2-18 Briefing Book Slides: 2011 SAMHSA/CSAT Summary Analytic File

  3. GAIN Data Overview (Chapter 2) Clients are 77% adolescents and 23% adults (age range from 9 to 73; 63% between the ages of 15 and 17; average 18.3; Chapter 2, slides 4, 7) upon admittance to substance abuse treatment.   Clients are 73% male (Chapter 2, slide 5) and 62% non-white (16% African American, 29% Hispanic, 13% multi-racial, and 4% other; Chapter 2, slide 6). In the past year prior to intake, 29% of clients fit abuse criteria and 48% fit criteria for dependence (Chapter 2, slide 11). Most clients (79%) first used substances before the age of 15 (Chapter 2, slide 13). Over 50% of clients were using some substance weekly at intake, with marijuana showing the highest levels of abuse and dependence (Chapter 2, slides 14, 15). Co-occurring issues are the norm in this group, with 65% of clients presenting with moderate to high levels of lifetime victimization (Chapter 2, slide 25), 62% with a co-occurring mental health issue (Chapter 2, slide 26), and 78% with any violence or illegal activity in the past year (Chapter 2, slide 36).  Highlights

  4. GAIN Data Overview (Chapter 2) - continued Using the GAIN, the costs of behaviors that are associated with substance use can be estimated based on cost estimates available from current research. In the past year, the average cost of health care utilization across clients was $10,099, with 10% of clients in the highest cost category representing 75% of the total health care utilization costs across clients (Chapter 2, slides 32, 34). The average cost of criminal activity in the past year was $276,153, with the 20% of clients in the highest cost category representing 97% of the total cost of crime across all clients (Chapter 2, slides 38, 40).  The average overall cost to society was $19,989 in the past year, with 13% of clients in the highest cost category representing 49% of the total costs to society across all clients (Chapter 2, slides 53, 55). Overall, there was a 19% increase in past month abstinence at 6 months post-intake (Chapter 2, slide 70). Eighty-five percent of clients reach initiation within 14 days of assessment, and 78% of clients were engaged for at least six weeks (Chapter 2, slide 76). Highlights

  5. Characteristics by Age (Chapter 5) Age does not have a consistent relationship with clinical problems at intake. While substance abuse and dependence are slightly lower for adults age 26+ than adolescents age 15-17 (61% vs. 81%; Chapter 5, slide 8) at intake, they do use more severe substances than adolescents (higher levels of cocaine (24% vs. 3%), opioid (16% vs. 2%), and amphetamine (16% vs. 5%) use (Chapter 2, slide 9)). Adults (age 18+), had lower levels of criminal behavior (23% with moderate/high crime) than other age groups (49% to 65% with moderate/high crime; Chapter 5, slide 20). Outcomes for age showed that there is a smaller change in abstinence from intake to 6 months for adults age 18+ (15%) than for 15-17 year olds (20%) or those under 15 (25%; Chapter 5, slide 40), but adults age 26+ also have higher overall levels of abstinence at all time periods (as high as 87% at three months; Chapter 5, slide 42). Highlights

  6. Characteristics by Gender (Chapter 6) Females have more clinical problems than males at intake (56% vs. 43% with five or more clinical problems; Chapter 6, slide 24) Specifically, females have more problems with severity of victimization (56% vs. 42% with high severity; Chapter 6, slide 15), mental health disorders (74% vs. 59% with one or more disorders; Chapter 6, slide 16), and physical health problems (55% vs. 42% with moderate/high problems; Chapter 6, slide 18). Males and females exhibit similar levels of violence and crime (36% vs. 32% with high crime; Chapter 6, slide 20), but males commit more violent crimes than females (41% vs. 30%; Chapter 6, slide 21). Outcomes for both genders are very similar; females had a slightly higher change in 6 month abstinence (23% vs. 18%; Chapter 6, slide 40). Highlights

  7. Characteristics by Race (Chapter 7) African Americans have the fewest clinical problems at intake (32% with five or more) and multi-racial clients have most (55% with five or more; Chapter 7, slide 24). Average Quarterly Cost to Society was very similar for all race groups (Chapter 7, slide 32); however health care costs were highest for Caucasians and multi-racial clients ($3,074 and $3,402 respectively) and lowest for Hispanics ($1,800; Chapter 7, slide 19). Cost of crime was highest for Hispanics ($852,574) and lowest for Caucasians ($250,470; Chapter 7, slide 22). No single group had the best outcomes overall; African Americans show the largest increase in 6 month abstinence (23%; Chapter 7, slide 40), but Hispanics met the most NOMS outcomes overall (78% with one or more and 30% with five or more; Chapter 7, slide 48). Highlights

  8. Characteristics by Substance Use Severity (Chapter 8) Clients with substance dependence in the past year have the highest levels of victimization (76% moderate/high severity; Chapter 8, slide 15), mental health disorders (81% with one or more disorders; Chapter 8, slide 16), and crime and violence (50% with high levels of crime; Chapter 8, slide 20) at intake. Dependent clients have the highest mean cost across all categories ($3,475 in health care utilization, $803,317 cost of crime, and $6,149 overall quarterly cost to society; Chapter 8, slides 19, 22, 32). Those with dependence also reach the highest level of NOMs outcome met at their last follow-up wave (83% with one or more; Chapter 8, slide 48). Characteristics by Risk of Homelessness (Chapter 9) Homelessness and risk of homelessness are associated with more clinical problems, including substance dependence (>60%; Chapter 9, slide 8), victimization (> 60% with high severity; Chapter 9, slide 15), co-occurring mental health disorders (>73% with one or more disorders; Chapter 9, slide 16), and physical health problems (>10% with high problems; Chapter 9, slide 18). Those who are currently homeless have the highest health care utilization costs ($4,618; Chapter 9, slide 19), and those at risk of homelessness have the highest cost of crime ($887,244; Chapter 9, slide 22). Currently homeless individuals reach the highest levels of NOMS outcomes met (86% with one or more; Chapter 9, slide 48). Highlights

  9. Characteristics by Severity of Victimization (Chapter 10) High victimization is associated with more substance dependence (60%; Chapter 10, slide 9), co-occurring mental health disorders (80% with one or more disorders; Chapter 10, slide 16), and crime and violence (50% with high crime; Chapter 10, slide 20). High victimization is also associated with higher costs across domains (cost of health care utilization, $3,483, cost of crime $977,567, overall quarterly cost to society $6,435; Chapter 10, slides 19, 22, 32). Those with high victimization have a smaller change in 6 month abstinence (17%) than those with moderate victimization (21%) or low victimization (22%; Chapter 10, slide 40), but meet approximately the same number of NOMS outcomes by last follow-up (80%, 78%, and 73% with one or more outcomes met respectively; Chapter 10, slide 48). Highlights

  10. Characteristics by Mental Health Disorders (Chapter 11) Those with externalizing mental health disorders are more likely to be adolescent (91%) and male (83%), while those with internalizing mental health disorders have a higher rate of adult (45%) and female (42%) clients than other groups (Chapter 11, slides 5, 6). Externalizing disorders are associated with higher levels of crime and violence (46% high crime) than internalizing disorders (21% high crime; Chapter 11, slide 20).   Quarterly Costs to Society increase from externalizing disorders ($4,051), internalizing disorders ($5,607), to both ($7,181; Chapter 11, slide 32).   Outcomes are slightly better for those with externalizing than internalizing disorders; they show a larger change in abstinence at 6 months (21% vs. 18% respectively; Chapter 11, slide 40). Highlights

  11. Characteristics by Physical Health (Chapter 12) Those with high levels of physical health problems are more likely to be female (43%) and adult (32%) than those with less severe health problems (Chapter 12, slides 5, 6).   Those with high physical health problems also have more substance dependence (61%; Chapter 12, slide 9), higher levels of victimization (62% with high severity; Chapter 12, slide 16), and more co-occurring mental health disorders (80% with one or more disorders; Chapter 12, slide 17) than those with lower levels of health problems.   As expected, cost of health care utilization is higher for those with high levels of health problems ($5,726) than those with moderate ($2,975) or low problems ($1,680; Chapter 12, slide 19).   Health problems do not appear to be associated with abstinence, but those with more health problems have a higher number of NOMS outcomes met at their last wave (86% with one or more outcomes met; Chapter 12, slide 48). Highlights

  12. Characteristics by Crime and Violence (Chapter 13) Those with high levels of crime are more likely to be adolescents (87%; Chapter 13, slide 5), have more dependence (67%; Chapter 13, slide 9), higher victimization (65% with high severity; Chapter 13, slide 16), and more mental health problems (86% with one or more disorders; Chapter 13, slide 17). As expected, those with high levels of crime and violence have the highest cost of crime ($1,465,582; Chapter 13, slide 22), as well as higher health care ($3,447; Chapter 13, slide 20), and quarterly costs ($6,509; Chapter 13, slide 32).   Those with higher levels of crime also have more NOMS outcomes met at their last wave (82% with one or more and 36% with five or more outcomes met; Chapter 13, slide 48). Characteristics by Intensity of Justice System Involvement (Chapter 14) Intensity of justice involvement does not have a consistent relationship with many characteristics. Those in jail 30+ days of the past 90 have lower substance use problems (68% with abuse or dependence; Chapter 14, slide 9); this is expected due to their time spent in a controlled environment before intake. Those in jail 30+ days of the past 90 also show a decrease in abstinence at follow-up (-10%); they have more opportunities to use after leaving jail (Chapter 14, slide 40). Highlights

  13. Characteristics by Grant Program (Chapter 15) The grant programs with the largest number of clinical problems were the Adolescent Treatment Model (ATM; 65% with five or more problems), Adolescent Residential Treatment (ART; 67% with five or more problems), and the Cannabis Youth Treatment (CYT; 53% with five or more problems; Chapter 15, slide 25) studies. The Adult Treatment Drug Court (ATDC) programs are unique in that they are the most Caucasian (62%; Chapter 15, slide 7), most female (62%; Chapter 15, slide 6), and have some of the most severe substance use problems (66% with past year dependence; Chapter 15, slide 9) at intake of all programs. They also seem to produce some of the most positive outcomes, including a 38% increase in abstinence from intake to 6 months (Chapter 15, slide 40)and among the highest number of NOMS outcomes met at last follow-up (81% with one or more; Chapter 15, slide 50). Highlights

  14. Characteristics by Level of Care (Chapter 16) As the number of clinical problems at intake increases, level of care becomes more intense (from outpatient services to short term residential treatment; Chapter 16, slide 25). Those entering residential treatment and continuing care have the highest cost to society before entering treatment (from $7,389 to $8,284 in the past 90 days; Chapter 16, slide 33).   Medium to long term residential programs produce a larger percent change in abstinence from intake to 6 months (30%; Chapter 16, slide 40) than other levels, and both short and long term residential programs meet a large number of NOMS outcomes at last wave (87% and 85% with one or more respectively; Chapter 16, slide 48). Characteristics by Treatment Type (Chapter 17) Those receiving local manualized treatments present with the largest number of clinical problems (Chapter 17, slide 25).   Evidence based treatments result in the greatest change in abstinence from intake to 6 months (24%, Chapter 17, slide 40).  Those receiving evidence based treatments are more likely to reach initiation, engagement, and receive continuing care (more than 55% with all 3 for A-CRA/ACC treatments; Chapter 17, slide 45). Highlights

  15. Unmet Need and Health Disparities (Chapter 18) More than 50% of clients report unmet need at 3 months for ASAM Dimensions B1 (Intoxication/Withdrawal; Chapter 18, slide 52), B2 (Physical Health; Chapter 18, slide 53), B3 (Mental Health; Chapter 18, slide 55) and B6 (Recovery Environment; Chapter 18, slide 61).   Significant disparities in unmet need by race are evident in 6 of 7 domains. Caucasians have lower unmet need for substance treatment (24%; Chapter 18, slide 51). Hispanics have higher unmet need for physical health treatment (63%; Chapter 18, slide 54). Hispanics and African Americans have higher unmet need for mental health treatment (84% and 80% respectively; Chapter 18, slide 56). African Americans also have the most unmet treatment readiness need (i.e., 24% are not engaged at 3 months; Chapter 18, slide 58). Unmet need for monitoring of relapse potential using urine or breathalyzer testing is highest for those classified as Other (32%; Chapter 18, slide 60). Unmet recovery environment need (i.e., no self-help attendance) is higher for African Americans and Hispanics (78% and 83% respectively; Chapter 18, slide 62). Highlights

  16. Unmet Need and Health Disparities (Chapter 18) - continued Significant gender disparities were found for: Physical and mental health treatment, such that males had higher unmet need (60% and 74% respectively; Chapter 18, slides 54, 56). Unmet need for monitoring of relapse potential using urine or breathalyzer testing is higher for females (25%; Chapter 18, slide 60). Males also have higher unmet recovery environment need (i.e., 76% with no self-help attendance; Chapter 18, slide 62). Highlights

  17. Table of Contents - 1 1. Slide Introduction 1.1. Slides Organization 1.2. Description of Dataset 1.3. Maps 2. All Data Overview 2.1. Risk and Protective Factors 2.1.1. Age 2.1.2. Gender 2.1.3. Race 2.1.4. Environment* 2.1.5. Risk of Homelessness 2.1.6. Substance Problem Recognition* 2.1.7. Substance Use Severity 2.1.8. Primary Substance 2.1.9. Substance Use Problems 2.1.10. Pattern of Weekly Use* 2.1.11. SUDs in Past Year by Major Substances* 2.1.12. Tobacco Diagnosis 2.1.13. Recovery Environment* 2.1.14. HIV Risk Scale 2.1.15. HIV Risk Change Index 2.1.16. Sex Partners 2.1.17. Severity of Victimization 2.1.18. Mental Health Disorders 2.1.19. Co-Occurring Psychiatric Problems* 2.1.20. Homicidal/Suicidal Thoughts Scale *Not included in breakout presentations for each breakout characteristics

  18. Table of Contents - 2 2.1.21. Para-Suicidal Index* 2.1.22. Family History of Physical Health Problems* 2.1.23. Health Problems Scale 2.1.24. System Involvement* 2.1.25. Health Care Utilization 2.1.26. Crime and Violence 2.1.27. Justice System Involvement 2.1.28. Major Clinical Problems 2.1.29. GI Behavior Change Scales* 2.1.30. Sources of Stress 2.1.31. Treatment Readiness 2.1.32. Self-Help Activities 2.1.33. Individual Strengths Self-Efficacy 2.1.34. General Social Support Strengths 2.1.35. Spiritual Social Support Strengths 2.1.36. Potential Mentors and Environmental Strengths 2.1.37. Quarterly Cost to Society 2.1.38. Problem Prevalence 2.1.39. Quality of Life 2.1.40. General Satisfaction 2.1.41. Funder* 2.1.42. Program 2.1.43. Level of Care 2.1.44. Treatment Type 2.2. Outcomes 2.2.1. Days of Substance Use* *Not included in breakout presentations for each breakout characteristics

  19. Table of Contents - 3 2.2.2. Past Month Abstinence 2.2.3. Recovery 2.2.4. GPRA Outcomes 2.2.5. NOMS Outcomes 2.2.6. Change in Scales Over Time* 3. Adolescent Treatment Overview 3.1. Risk and Protective Factors 3.2. Outcomes 4. Justice Treatment Overview 4.1. Risk and Protective Factors 4.2. Outcomes Presentations by Patient Characteristics 5. Subset of Overview by Age 5.1. Risk and Protective Factors 5.2. Outcomes 6. Subset of Overview by Gender 6.1. Risk and Protective Factors 6.2. Outcomes 7. Subset of Overview by Race 7. 1. Risk and Protective Factors 7 2. Outcomes Presentations by Patient Problem Severity 8. Subset of Overview by Substance Use Severity *Not included in breakout presentations for each breakout characteristics

  20. Table of Contents - 4 8. 1. Risk and Protective Factors 8. 2. Outcomes 9. Subset of Overview by Homeless Risk 9. 1. Risk and Protective Factors 9. 2. Outcomes 10. Subset of Overview by Severity of Victimization 10.1. Risk and Protective Factors 10.2. Outcomes 11. Subset of Overview by Mental Health Disorders 11.1. Risk and Protective Factors 11.2. Outcomes 12. Subset of Overview by Health Problems 12.1. Risk and Protective Factors 12.2. Outcomes 13. Subset of Overview by Crime and Violence 13.1. Risk and Protective Factors 13.2. Outcomes 14. Subset of Overview by Intensity of Justice System Involvement 14.1. Risk and Protective Factors 14.2. Outcomes

  21. Table of Contents - 5 Presentations by Non-Patient Characteristics 15. Subset of Overview by Program 15.1. Risk and Protective Factors 15.2. Outcomes 16. Subset of Overview by Level of Care 16.1. Risk and Protective Factors 16.2. Outcomes 17. Subset of Overview by Treatment Type 17.1. Risk and Protective Factors 17.2. Outcomes 18. Other Special Topics 18.1. GLBTQ Status† 18.2. GAIN Placement Cells by ASAM Dimension 18.3. ASAM Planning statements 18.4. Individual Clinical Profile 18.5. Unmet need 18.6. Summary profiles by instrument 18.6.1. GAIN Short Screener Problem Profile 18.6.2. GAIN Quick Version 3 Problem Profile 18.6.3. GAIN-I Problem Profile– Main Scales 18.6.4. GAIN-I Problem Profile—Subscales † By each breakout characteristic

  22. Table of Contents - 6 18.6.4.1. Substance problems 18.6.4.2. Internalizing MH Problems 18.6.4.3. Externalizing MH Problems 18.6.4.4. Crime/Violence Problems 18.6.4.5. General Factors/ Stress Problems 18.6.4.6. Physical Health Problems 18.6.4.7. Risk Behavior problems 18.7. Mod/Hi Problem Count by Instrument† 18.8. Treatment Episode Dataset 19. Methods Appendix 19.1. Administration Time 19.2. Valid N for Core and Optional Items† 19.3. Follow-up Rates† 19.4. Average N of Follow-Ups and Time to last Follow-Up† 19.5. GAIN Administration Fidelity Index† 19.6. Summary of Psychometrics 19.7. Accessing the data for Secondary Analysis 20. Briefing Slides Summary 20.1. Highlights 20.2. Table of Contents 20.3. Style Guidelines † By each breakout characteristic

  23. Table of Contents - 7 20.4. Document Accessibility 20.5. Acknowledgment 20.6. Slide Citation 21. Index

  24. Style & Organization Guide • Order • Slides in the overview and breakout chapters are organized as • Risk and protective factors • Outcomes • Select Risk and protective factor and Outcome slides are presented by breakouts in separate files. • Overview data for Adolescent Treatment data and Justice Program data are presented in separate files. • Breakouts variables are: • Age • Gender • Race • Substance Use Severity • Risk of Homelessness • Severity of Victimization • Mental Health Disorders • Health Problems • Crime and Violence • Intensity of Justice System Involvement • Program • Level of Care • Type of Treatment

  25. Style & Organization Guide - continued • Sorting • Breakout values and other column graphs are shown left to right from the lowest severity level to highest. • Data are presented with the subjectively bad level (e.g. more problems or less support) on top for column graphs and on the far right for bar graphs. • Colors • Colors are kept constant across graphs so that each category is always the same color (i.e. age < 15 years=red). • Colors can suggest order. • Colors used are on a continuum progress from subjectively bad (shades of red or pink) to subjectively good (blues and greens). • Severity groups where Low equals zero are formatted red, yellow, green. • Severity groups where Low includes values above zero are formatted red, gold, yellow. • Neutral colors matching the slide template are used when an item is not ordered by severity (e.g. race, program, funder).

  26. Style & Organization Guide - continued • Graphs with columns generally show different groups of people. • Graphs with bars (rows) generally show different variables across all people. • Percents are shown in data labels for at least the most important level when possible. • Cut points of severity groups are provided in the legends in parentheses. • When possible, scales are explained with a bar graph of the individual items that comprise the scales followed by the grouped version of the scale on a secondary axis. • The number of records for each slide does vary. Core items generally have 29,782 records; optional items generally have 13,575 records. • On slides with multiple items, the N in the source note is the average across all items, unless otherwise noted

  27. Document Accessibility • This document is Section 508 compliant for those with visual impairment. • Descriptions of slide content are located in the speaker’s notes section of each slide. • A stand alone Microsoft Word document containing this information can also be made available upon request. • Please contact the Analysis Team at GAINeval@chestnut.org for assistance using this file or accessing GAIN data.

  28. Detailed Acknowledgements Any opinions about this data are those of the authors and do not reflect official positions of the government or individual grantees. Please include the following acknowledgement and disclaimer if you use these data: This presentation was supported by analytic runs using data provided by Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT) under Contracts 207-98-7047, 277-00-6500, 270-2003-00006 , 270-07-0191, and 270-2012-00001 using data provided by the following 230 grantees: TI11317 TI11321 TI11323 TI11324 TI11422 TI11423 TI11424 TI11432 TI11433 TI11871 TI11874 TI11888 TI11892 TI11894 TI13190 TI13305 TI13308 TI13313 TI13322 TI13323 TI13344 TI13345 TI13354 TI13356 TI13601 TI14090 TI14188 TI14189 TI14196 TI14252 TI14261 TI14271 TI14272 TI14283 TI14311 TI14315 TI14376 TI15413 TI15415 TI15421 TI15433 TI15438 TI15446 TI15447 TI15458 TI15461 TI15466 TI15467 TI15469 TI15475 TI15478 TI15479 TI15481 TI15483 TI15485 TI15486 TI15489 TI15511 TI15514 TI14261 TI14267 TI14271 TI14272 TI14283 TI14311 TI14315 TI14376 TI15413 TI15415 TI15421 TI15433 TI15438 TI15446 TI15447 TI15458 TI15461 TI15466 TI15467 TI15469 TI15475 TI15478 TI15479 TI15481 TI15483 TI15485 TI15486 TI15489 TI15511 TI15514 TI15524 TI15527 TI15545 TI15562 TI15577 TI15584 TI15586 TI15670 TI15671 TI15672 TI15674 TI15677 TI15678 TI15682 TI15686 TI16386 TI16400 TI16414 TI16904 TI16915 TI16928 TI16939 TI16961 TI16984 TI16992 TI17046 TI17070 TI17071 TI17334 TI17433 TI17434 TI17446 TI17475 TI17476 TI17484 TI17486 TI17490 TI17517 TI17523 TI17534 TI17535 TI17547 TI17589 TI17604 TI17605 TI17638 TI17646 TI17648 TI17673 TI17702 TI17719 TI17724 TI17728 TI17742 TI17744 TI17751 TI17755 TI17761 TI17763 TI17765 TI17769 TI17775 TI17779 TI17786 TI17788 TI17812 TI17817 TI17821 TI17825 TI17830 TI17831 TI17847 TI17864 TI18406 TI18587 TI18671 TI18723 TI18735 TI18849 TI19313 TI19323 TI19911 TI19942 20084 20085 20086 TI20017 TI20759 TI20781 TI20798 TI20806 TI20827 TI20828 TI20847 TI20848 TI20849 TI20852 TI20865 TI20870 TI20910 TI20921 TI20924 TI20938 TI20941 TI20946 TI21551 TI21580 TI21585 TI21597 TI21624 TI21632 TI21639 TI21682 TI21688 TI21705 TI21714 TI21748 TI21774 TI21788 TI21815 TI21874 TI21883 TI21890 TI21892 TI21948 TI22424 TI22425 TI22443 TI22513 TI22544 TI22695 TI22874 TI22907 TI23037 TI23056 TI23064 TI23096 TI23101 TI23174 TI23186 TI23188 TI23195 TI23196 TI23197 TI23200 TI23202 TI23204 TI23224 TI23228 TI23244 TI23247 TI23265 TI23270 TI23278 TI23279 TI23296 TI23298 TI23304 TI23310 TI23312 TI23316 TI23322 TI23323 TI23325 TI23336 TI23345 TI23346 TI23348 655373 655374 The authors thank these grantees and their study clients for agreeing to share their data

  29. How to cite this document • GAIN Coordinating Center (2012). Briefing Book Slides on All Grantees in the 2011 SAMHSA/CSAT Summary Analytic File [Electronic Version]. Normal, IL: Chestnut Health Systems. November 2012. Retrieved from: http://www.gaincc.org/slides • Contributors and reviewers at the GCC listed alphabetically include Vinetha Belur, Megan Catlin, Michael Dennis, Barbara Estrada, Rod Funk, Rachael Hand, Pamela Ihnes, Melissa Ives, Kathryn Modisette, and Corey Smith

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