Protocol - Service Utilization and Cost

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The Global Appraisal of Individual Needs (GAIN) uses 18 items to ask about days and times that different types of services were used in the past 90 days (treatment, school, incarceration). Costs have been derived for each item by economists from numerous sources. Costs can be adjusted for inflation using the Consumer Price Index. The costs are each multiplied by the number of times/days reported to the corresponding GAIN item and summed to get the quarterly cost for the study population.

Specific Instructions

Collect data on service utilization from the 18-item Global Appraisal of Individual Needs (GAIN) protocol; multiply these by unit prices/costs and sum. Unit costs can be updated to current market values using original source documents, adjusted based on the Consumer Price Index (CPI) to standardize on a given year or be replaced with local costs where available. In all cases, cost assumptions should be explicitly stated when reporting the results. Note, additional costs (service utilization) might also be exhibited by a population (e.g., social welfare or social services) and intangible costs are not captured by these estimates. Therefore one must be careful interpreting information from just this scale as the full societal cost.


Limited Availability


Summary of Global Appraisal of Individual Needs (GAIN)

The Global Appraisal of Individual Needs (GAIN) originated in 1993 as a collaborative effort between clinicians, researchers, and policymakers to create a comprehensive and standardized biopsychosocial assessment tool.

The GAIN has developed into a progressive and integrated family of instruments with a series of measures and computer applications designed to support a number of treatment practices, including:

· Initial screenings (GAIN-SS)

· Brief interventions and referrals (GAIN-Q3)

· Standardized clinical assessments for diagnosis, placement, and treatment planning (GAIN-I)

· Monitoring change in clinical status, service utilization, and costs to society (GAIN-M90)

· Subgroup and program-level needs assessment, evaluation, and secondary analysis

The GAIN family of instruments is appropriate for use with both adolescents and adults from a variety of populations in various levels of care, including: outpatient, intensive outpatient, short-term residential, long-term residential, therapeutic community, justice programs, school-based programs, welfare programs, co-occurring disorder programs, and primary health care programs

The Global Appraisal of Individual Needs (GAIN) instruments can be obtained at https://gaincc.org/instruments/

Personnel and Training Required

Interviewer must be trained and found competent to conduct personal interviews with individuals from the general population. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs


Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered or interviewer-administered questionnaire


Adolescent, Adult, Senior, Pregnancy


Adolescents and adults aged 12 years or older

Selection Rationale

More than 80 percent of substance abuse treatment is publicly funded, so historically the arguments for providing it have been around the extent to which these costs are offset by reductions in other costs to society associated with reduced substance use. The least controversial of these costs to society are those associated with the cost of tangible service utilization (e.g., emergency rooms) for which unit costs are readily available. These are considered a lower bound because they do not include the cost to society of other important expensive outcomes for which it is much more difficult to give an explicit value (e.g., avoiding a case of AIDS, a premature baby, an assault or rape). Using the 18 items from the Global Appraisal of Individual Needs (GAIN), a quarterly burden (benefit) to society associated with substance use (treatment) for this population is derived.


English, Other languages available at source

Derived Variables


Process and Review

The Expert Review Panel #3 (ERP 3) reviewed the measures in Alcohol, Tobacco and Other Substances, and Substance Abuse and Addiction domains.

Guidance from ERP 3 includes:

• Changed name of Measure

• Updated protocol

• New Data Dictionary

Back-compatible: Not back-compatible (vastly different than previous protocol which would require a new data dictionary) and not recommended for use (discredited or no longer considered broadly validated)

Protocol Name from Source

Global Appraisal of Individual Needs (GAIN)


Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN): Administration guide for the GAIN and related measures. Version 5. Bloomington, IL: Chestnut Health Systems.

French, M. T., Roebuck, M. C., Dennis, M. L., Diamond, G., Godley, S. H., Liddle, H. A., & Tims, F. M. (2003). Outpatient marijuana treatment for adolescents: Economic evaluation of a multisite field experiment. Evaluation Review, 27(4), 421-459.

Salomé, H. J., French, M. T., Scott, C. K., Foss, M., & Dennis, M. L. (2003). Investigating the variation in the costs and benefits of addiction treatment: Econometric analysis of the Chicago Target Cities Project. Evaluation and Programming Planning, 26(3), 325-338.

General References

American Medical Association. (2005). Medicare physician fee schedule. Chicago: Author.

Criminal Justice Institute, Inc. (2001). 2000 corrections yearbook. Middletown, CT: Author.

French, M. T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469.

Light, A. (2001). In-school work experience and the returns to schooling. Journal of Labor Economics, 19(1), 65-93.

McCollister, K. E., French, M. T., & Fang, H. (2010). The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol Dependence, 108, 98-109.

Salomé, H. J., French, M. T., Scott, C. K., Foss, M., & Dennis, M. L. (2003). Investigating the variation in the costs and benefits of addiction treatment: Econometric analysis of the Chicago Target Cities Project. Evaluation and Programming Planning, 26(3), 325-338.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX560702000000 Protocol 560702 - proprietary. Check DCW for more
contact. show less
Substance Use-related Co-morbidities and Health-related Outcomes
Measure Name

Service Utilization and Cost

Release Date

November 21, 2016


This measure takes the days/times in the past 90 days of self-reported service utilization variables related to health care, mental health care, and school and justice system involvement and multiplies them by a unit price of those services. These costs are then summed to get a quarterly burden of substance use for a study sample or can be used to demonstrate gains in these domains associated with treatment/recovery.


The purpose of this measure is to estimate the tangible cost of service utilization during the past quarter, to identify subgroups of particularly expensive clients, to examine the extent to which the cost of treatment is offset by reductions in costs to society in a study sample, or to compare two or more interventions in terms of the relative cost-effectiveness or benefit cost.


Global Appraisal of Individual Needs, GAIN, Cost effectiveness, Cost-benefit analysis, Service utilization, treatment, Emergency room, hospitalization, Outpatient service, Criminal justice costs, Criminal justice savings, SAA, Substance Use-related Co-morbidities and Health-related Outcomes, proprietary

Measure Protocols
Protocol ID Protocol Name
560702 Service Utilization and Cost

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