Evidence-based policymaking: Lessons from the Chilean Substance Use Treatment Policy.

BACKGROUND: Evidence-based policymaking is a guiding paradigm of substance use treatment (SUT) policy, that seeks to prioritise scientific criteria over other concerns (e.g., economic, political) when addressing policy decisions. We provide a comprehensive analysis of the context and mechanisms that enable and constrain evidence to improve the Chilean SUT policy and draw some lessons that might be useful to other contexts, particularly low and middle-income countries. METHODS: This study relied on an interpretive case study design based on the principles of realist evaluation. We included interviews (N≈17) with international, national, regional, and local policymakers and experts, as well as technical and clinical teams from private and public care SUT providers in Chile. RESULTS: Complex sets of institutional realities and notions of 'evidence' shared by actors - between other elements- guide the SUT policy decisions and shape the specific type of evidence considered relevant. Evidence is understood in Chile in narrow terms, and national non-experimental research is often overlooked. This limits the possibility of studying other research questions that could contribute to improving and informing SUT policy. CONCLUSIONS: In contexts where addiction research resources are limited, it appears necessary to re-frame the notion of "evidence", to consider relevant national non-experimental knowledge to strengthen SUT policy and achieve its goals. Indeed, this study is an example of how methodological approaches, such as case analysis, can provide a powerful heuristic alternative contribution to the local and global mental health debate.

Modelo Texas Christian University para evaluación y tratamiento de trastornos por uso de sustancias / Texas Christian University Model for assessment and treatment of substance use disorders

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Texas Christian University Model for Assessment and Treatment of Substance Use Disorders. This article aims to present a critical review of the literature regarding the Texas Christian University (TCU) Model in the field of assessment and treatment of substance use disorders (SUD). First, the background that prompted the development of the TCU Model is summarized. Subsequently, the central aspects of the model are detailed, including an assessment of empirical research that supports it. Then, the assessment tools developed within the model are described, with a focus on the psychometric properties of the instruments. Finally, the intervention strategies that constitute the TCU Treatment System are presented, emphasizing the evidence supporting the utilization of those interventions. The last three sections end up with a critical analysis in which the positive and negative aspects of the model, the assessment tools, and the associated interventions are presented (AU)

Adaptation and Validation of the Instrument Treatment Outcomes Profile to the Chilean Population.

This study aims to psychometrically validate the Chilean version of the treatment outcomes profile (TOP), an instrument that can be used by treatment centers to monitor the results of drug and alcohol treatments. Specifically, this study is interested in evaluating the inter-rater reliability, concurrent validity, change sensitivity and discriminant and construct validity of this instrument. The TOP was modified to reflect the Chilean context and then applied in three successive stages: an initial application at the beginning of treatment, a retest after 1week, and a follow up after a month. The sample was composed of 411 users of different types of drugs who were in treatment centers in the three largest regions of the country. The TOP reliability was greater than .75 for most items. Regarding concurrent validity, all the coefficients were in the expected direction and statistically significant. Change over time, as measured by Cohen's d statistic and the Reliable Change Index, was significant for most items. Users in treatment for less than 3months showed higher alcohol consumption (odds ratio [OR]=1.07; 95% confidence interval [95% CI]: 1.01-1.13), poorer psychological health (OR=0.94; 95% CI: 0.87-1.00), fewer days worked (0.56; 0.95-0.99) and poorer housing conditions (OR=2.76; 95% CI: 1.22-6.23) than did their counterparts who had more than 3months of treatment. Researchers extracted six components with eigenvalues greater than one, accounting for 69.0% of the total variance. In general, the Chilean TOP is a reliable and valid mechanism to monitor outcomes of people treated for problems with drug and alcohol abuse in Chile, but further validation work is required in some dimensions.

Evidencia de validez en Chile del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) / Validity evidence of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Chile

El objetivo del estudio fue analizar la validez de la versión chilena de un instrumento para la identificación de diferentes niveles de riesgo asociado al consumo de alcohol, tabaco, marihuana y cocaína(Alcohol, Smoking and Substance Involvement Screening Test, ASSIST).Se evaluó la fiabilidad y consistencia del instrumento además dela validez concurrente y discriminante. La muestra fue de 400usuarios de servicios de tratamiento drogas y alcohol ambulatorios y residenciales de la atención primaria de salud, comisarías y empresas. La consistencia interna obtenida fue alta (Alcohol α= .86. marihuana α= .84 y cocaína α= .90). El coeficiente de correlación intraclase (CCI) con la comparación test-retest fue buena para Alcohol (CCI = .66), marihuana (CCI = .74) y cocaína (CCI =.80). Se observó una buena correlación entre los puntajes del ASSIST el puntaje del AUDIT (r de Pearson = .85), ASI-Lite (r entre .66 y .83 para tabaco, alcohol, marihuana y cocaína) y SDS (r = .65). El punto de corte original para la detección del riesgo alto es de 27 puntos, sin embargo, considerando un mejor balance entre sensibilidad y especificidad se modificó ese corte a 21. Los resultados obtenidos en éste estudio demostraron las buenas propiedades psicométricas del ASSIST para la detección de distintos niveles de riesgo asociados al consumo de sustancias en población general de Chile

This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies. The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson’s r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population

[Validity evidence of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Chile]. / Evidencia de validez en Chile del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies. The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson’s r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population.