Protocol - Internalizing, Externalizing, and Substance Use Disorders Screener
Description
The Global Appraisal of Individual Needs-Short Screener (GAIN-SS) contains a five-item internal disorder screener, a five-item external disorder screener, and a five-item substance use disorder screener. Each item measures the recency of the problem (e.g., in the past month, 2-12 months ago, more than one year ago, or never).
Specific Instructions
Because the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) is a self-reported screener, it should supplement (not replace) the judgment of clinical line staff, who may have urine test results, collateral reports, or other background information available to them. This is particularly important when screening in settings that involve jails, welfare investigations, or other situations where the fear of possible consequences or concerns about confidentiality may influence client answers or affect the validity of their responses.
The Behavioral Health Screener, another PhenX measure found in the Substance Abuse and Addiction Specialty Collections, contains the same questions from the internal disorder, external disorder, and substance use screeners. Therefore, selecting these two protocols together will result in duplicated questions.
Availability
Protocol
The following questions are about common psychological, behavioral, and personal problems. These problems are considered significant when you have them for 2 or more weeks, when they keep coming back, when they keep you from meeting your responsibilities, or when they make you feel like you can’t go on.
After each of the following questions, please tell us the last time, if ever, you had the problem, by answering whether it was in the past month, 2 to 12 months ago, more than 1 year ago, or never.
1. When was the last time that you had significant problems with . . .
a. feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
b. sleep trouble, such as bad dreams, sleeping restlessly, or falling asleep during the day?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
c. feeling very anxious, nervous, tense, scared, panicked, or like something bad was going to happen?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
d. becoming very distressed and upset when something reminded you of the past?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
e. thinking about ending your life or committing suicide?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
2. When was the last time that you did the following things two or more times?
a. Lied or conned to get things you wanted or to avoid having to do something?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
b. Had a hard time paying attention at school, work, or home?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
c. Had a hard time listening to instructions at school, work, or home?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
d. Were a bully or threatened other people?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
e. Started physical fights with other people?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
3. When was the last time that . . .
a. you used alcohol or other drugs weekly or more often?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
b. you spent a lot of time either getting alcohol or other drugs, using alcohol or other drugs, or recovering from the effects of alcohol or other drugs (e.g., feeling sick)?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
c. you kept using alcohol or other drugs even though it was causing social problems, leading to fights, or getting you into trouble with other people?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
d. your use of alcohol or other drugs caused you to give up or reduce your involvement in activities at work, school, home, or social events?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
e. you had withdrawal problems from alcohol or other drugs, like shaky hands, throwing up, having trouble sitting still or sleeping, or you used any alcohol or other drugs to stop being sick or avoid withdrawal problems?
3 [ ] Past month
2 [ ] 2 to 12 months ago
1 [ ] 1+ years ago
0 [ ] Never
Scoring and interpretation
The three subscreeners consist of the following items:
- 1a to 1e for the Internalizing Disorder Screener (IDScr)
- 2a to 2e for the Externalizing Disorder Screener (EDScr)
- 3a to 3e for the Substance Disorder Screener (SDScr)
The count of past-month (3’s) responses is used as a measure of change. The count of past-year (3’s or 2’s) responses is used to predict past year/current diagnosis. The count of lifetime (3’s, 2’s, or 1’s) responses is used to predict lifetime diagnosis. Counts are triaged into low (0 symptoms), moderate (1-2 symptoms), and high (3 or more symptoms) severity. Remission overall or in a given area is defined as lifetime "moderate/high" severity but no symptoms in the past month (early) or past year (sustained).
Be sure to count, instead of sum, the raw answers. For example, if the client’s responses for the items in the IDScr were:
1a = 3 (past month)
1b = 2 (2-12 months ago)
1c = 3 (past month)
1d = 1 (more than 12 months ago)
1e = 0 (never)
Then, the IDScr past year score would be 3, since 1a, 1b, and 1c reflect past-year symptoms. The past-month version would be the count of the 3’s, and lifetime would be the count of 1’s, 2’s, and 3’s.
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
None
Requirements
| Requirement Category | Required |
|---|---|
| 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
Lifestage
Adolescent, Adult, Senior, Pregnancy
Participants
Adolescent (13-17)
Adult (18+)
Selection Rationale
The full Global Appraisal of Individual Needs (GAIN) is a standardized instrument that integrates clinical and research assessment for people presenting for substance abuse treatment. The GAIN-Short Screener (GAIN-SS) is designed to provide valid measures of substance abuse severity overall and in the dimensions of emotional/behavioral problems (including internalizing, externalizing, and substance use disorders) in both adolescent and adult populations. A fourth subscreener, on crime and violence, is not included in this protocol in order to reduce participant burden.
GAIN-SS was developed by selecting items from the full GAIN, based on Rasch analysis, and was validated through internal consistency, efficiency, and receiver operating characteristics (ROC). It is designed for use in general populations to identify quickly and accurately who would have a disorder on the full GAIN (typically, a requirement for treatment entry in behavioral health); to rule out those who would not; and to serve as a measure of change in these same symptoms.
Psychometrics: For both adolescents and adults, GAIN-SS has good internal consistency (alpha of .96 on the complete 20-item screener); was highly correlated (r = 0.84 to 0.94) with the 123-item scales in the full GAIN-Initial; had excellent sensitivity (90% or more) for identifying people with a disorder; and had excellent specificity (92% or more) for correctly ruling out people who did not have a disorder. This screener can also measure change in symptoms over time (Dennis, Chan, & Funk, 2006).
Language
English, Other languages available at source
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Human Phenotype Ontology | Presence of xenobiotic | HP:0031838 | HPO |
| caDSR Form | PhenX PX580101 - Internalizing Externalizing And Substance Use Disorders | 6231041 | caDSR Form |
Derived Variables
None
Process and Review
Not applicable.
Protocol Name from Source
Global Appraisal of Individual Needs-Short Screener (GAIN-SS)
Source
Dennis, M. L., Chan, Y.-F., & Funk, R. R. (2006). Development and validation of the GAIN Short Screener (GAIN-SS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. American Journal on Addictions, 15(Suppl. 1), 80-91.
General References
Dennis, M. L., Chan, Y.-F., & Funk, R. (2006). Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing, and substance use disorders and crime/violence problems among adolescents and adults. American Journal on Addictions, 15(Suppl. 1), 80-91.
Dennis, M. L., Feeney, T., Hanes-Stevens, L., & Bedoya, L. (2008). GAIN-SS: Global Appraisal of Individual Needs-Short Screener (GAIN-SS) administration and scoring manual version 2.0.3. Bloomington, IL: Chestnut Health Systems.
Lucenko, B., Mancuso, D., & Estee, S. (2008). Co-occurring disorders among DSHS clients: A report to the legislature as required by section 601 (2) of the Omnibus Treatment of Mental and Substance Abuse Disorders Act of 2005 (Report No. 3.32). Olympia, WA: Washington State Department of Social and Health Services.
McDonnell, M. G., Comtois, K. A., Voss, W. D., Morgan, A. G., & Ries, R. K. (2009). Global Appraisal of Individual Needs Short Screener (GSS): Psychometric properties and performance as a screening measure in adolescents. American Journal of Drug and Alcohol Abuse, 35(3), 157-160.
Protocol ID
580101
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX580101_Alcohol_Drugs_Caused_Reduced_Involvement | ||||
| PX580101030400 | When was the last time that your use of more | N/A | ||
| PX580101_Committing_Suicide | ||||
| PX580101010500 | When was the last time that you had more | N/A | ||
| PX580101_Continued_Using_Alcohol_Drugs | ||||
| PX580101030300 | When was the last time that you kept using more | N/A | ||
| PX580101_Distressed_About_Past | ||||
| PX580101010400 | When was the last time that you had more | N/A | ||
| PX580101_Feeling_Anxious_Nervous | ||||
| PX580101010300 | When was the last time that you had more | N/A | ||
| PX580101_Feeling_Depressed_Hopeless | ||||
| PX580101010100 | When was the last time that you had more | N/A | ||
| PX580101_Hard_Time_Listening_To_Instructions | ||||
| PX580101020300 | When was the last time that you did the more | N/A | ||
| PX580101_Hard_Time_Paying_Attention | ||||
| PX580101020200 | When was the last time that you did the more | N/A | ||
| PX580101_Lied_Or_Conned | ||||
| PX580101020100 | When was the last time that you did the more | N/A | ||
| PX580101_Lot_Of_Time_Alcohol_Drugs | ||||
| PX580101030200 | When was the last time that you spent a lot more | N/A | ||
| PX580101_Sleep_Trouble | ||||
| PX580101010200 | When was the last time that you had more | N/A | ||
| PX580101_Started_Physical_Fights | ||||
| PX580101020500 | When was the last time that you did the more | N/A | ||
| PX580101_Threatened_Other_People | ||||
| PX580101020400 | When was the last time that you did the more | N/A | ||
| PX580101_Used_Alcohol_Or_Drugs_Weekly | ||||
| PX580101030100 | When was the last time that you used alcohol more | N/A | ||
| PX580101_Withdrawal_Problems | ||||
| PX580101030500 | When was the last time that you had more | N/A | ||
Measure Name
Internalizing, Externalizing, and Substance Use Disorders Screener
Release Date
February 24, 2012
Definition
An instrument used to identify behavioral health disorders, including internalizing psychiatric disorders, externalizing psychiatric disorders, and substance use disorders.
Purpose
The purpose of this measure is to screen in three main dimensions of emotional/behavioral problems (internalizing, externalizing, and substance use disorders) in both adult and adolescent populations in the past month, year, and lifetime.
Keywords
External Disorders, GAIN-SS, Global Appraisal of Individual Needs-Short Screener, Internal Disorders, Substance Use Disorders, SAA, substance abuse and addiction, proprietary
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 580101 | Internalizing, Externalizing, and Substance Use Disorders Screener |
Publications
Snell, M., et al. (2021) A longitudinal assessment of nicotine dependence, mental health, and attempts to quit Smoking: Evidence from waves 1-4 of the Population Assessment of Tobacco and Health (PATH) study. Addictive Behaviors. 2021 April; 115: 9. doi: 10.1016/j.addbeh.2020.106787