European Addiction Severity Index (EuropASI) i en oppfølgingsstudie av narkotikabrukere i behandling. Refleksjon om kvaliteter ved instrumentet for forskning og praksisformål

Abstract

EuropASI er for første gang i Norge benyttet i en omfattende oppfølgingsstudie av narkotikabrukere i behandling. Instrumentet fanger kompleksiteten i rusmiddelproblemene og klientens egen refleksjon, og dette er blant styrkene som trekkes fram i denne SIRUS-rapporten av Grete Lauritzen.

Rapporten beskriver og evaluerer bruken av verktøyet European Addiction Sverity Index (EuropASI) i en oppfølgingsstudie av narkotikabrukere i behandling. Rapporten vurderer verktøyet kritisk både i en forskningssammenheng og for klinisk bruk. EuropASI er den europeiske utgaven av et strukturert kartleggingsverktøy, som er utviklet i USA og har fått stor internasjonal utbredelse og anerkjennelse.

Oppfølgingsstudie Underlagsmaterialet for evalueringen er studien "Hvilken nytte for hvem, og til hvilken kostnad?". Her er nærmere 500 narkotikabrukere, rekruttert fra 20 norske behandlingstiltak intervjuet ved inntak i behandling og ved fire oppfølginger i perioden 1998 til 2009. EuropASI ble valgt som hovedinstrument for studien og ble benyttet for å beskrive klientene ved inntak og for å måle endring i problembelastning over tid.

Flerdimensjonalt verktøy EuropASI er et flerdimensjonalt kartleggingsverktøy med syv hovedområder: fysisk helse, utdanning og arbeid, alkoholbruk, narkotikabruk, kriminalitet, familie og sosiale relasjoner og psykisk helse. Denne konstruksjonen blir vurdert særlig positivt fordi den bidrar til å kartlegge og uttrykke kompleksiteten i klientenes situasjon.

Opplæring og videreføring En nasjonal opplæringsstandard er utviklet etter modell fra European Addiction Training Institute (Nederland), og undervisningen er forankret ved SERAF. I 2011 vil en faggruppe vurdere den nylig reviderte (sjette)versjonen av ASI for bruk i Norge.

This paper describes and evaluates the charting tool European Addiction Severity Index (EuropASI) in a research context and for clinical use.

The background for this report is the follow-up study: «Hvilken nytte, for hvem og til hvilken kostnad?» [What utility, for whom and at what cost?] in which nearly 500 drug abusers recruited from 20 Norwegian treatment facilities were interviewed from 1998 to 2009. The interviews were conducted with clients upon admission for treatment, and then after one, two, seven and ten years. EuropASI has been selected as the main instrument for this study, i.e. to describe clients upon admission and for charting changes in the scope of their problems. Experiences and data from the three first interviews are included in the report. More than ten years of experience teaching in the use of EuropASI as well as feedback from treatment facilities which implemented the instrument have provided additional background material and contributed here to reflection and evaluation.

The main question discussed in this report is:

What are the strengths and weaknesses of EuropASI with regards to charting drug abusers in treatment and evaluating changes in their burden of problems?

1. How suitable is EuropASI as the main instrument for describing a client selection in a research study? 2. How is it suited for measuring changes in clients' situations after the initiation of treatment? 3. What utility does EuropASI appear to have in assessment and treatment planning/conducting treatment?

EuropASI is described by means of its construction and form as a standardised, structured charting tool and is generally placed within a quantitative knowledge tradition. The method for evaluating qualities of the instrument has been the use of concepts reliability and validity as analytical axes. Material from the research study is introduced to indicate variables and scales of measurement. Chief emphasis has been put on a detailed review of selected variables in the initial treatment admissions interview to indicate psychometric qualities and weaknesses in questions forming the baseline in the study. The measurements of clients' changes as registered by EuropASI are made evident and evaluated by means of data from two follow-up interviews.

EuropASI is a multi-dimensional instrument with seven primary areas in addition to demographical information:

1. Physical health 2. Education- employment and means of support 3. Alcohol 4. Narcotic substances and medications 5. Criminality 6. Family and social relations 7. Mental health.

Many of the variables are continual, enabling the scaling of problem seriousness. Some of the questions asked are of an objective, verifiable character. But most are based on the clients' subjective reporting. Specific questions also solicit the clients' own considerations of the gravity of their problems and opinion of treatment needs.

The multi-dimensional approach is evaluated as a strongpoint of the instrument. In the description of clients, substance use is perceived as one element in a composite and complex array of problems. Through the wide range of variables within many dimensions, changes in the burden of problems can be analysed and important covariations ascertained. In clinical activity, EuropASI is utilised to shed light on the many facets a drug abuse problem often consists of, thus underscoring the need for a broad intervention and multidisciplinary understanding. In interviews during admittance for initial treatment, the instrument generally uses time references of «the past 30 days» and «earlier in life». This provides not only a reference for perceiving current problems but also for difficulties within a longer time-line. «The past 30 days» is a characteristic time frame for measuring changes. The weaknesses posed by this narrow window are pointed out.