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The GAIN-Q (GQ):
Development and Validation of
a Substance Abuse and Mental
Health Brief Assessment
Janet C. Titus, Ph.D.
Michael L. Dennis, Ph.D.
Lighthouse Institute
Chestnut Health Systems
Titus, J. C., & Dennis, M. L. (2003). The GAIN-Quick (GQ): Development and Validation of a Substance Abuse and Mental Health Brief Assessment.
Poster (#83) presented at the 65th Annual Scientific Meeting of the College for Problems on Drug Dependence (CPDD), Miami, Florida.
Abstract
The Global Appraisal of Individual Needs-Quick (GAIN-Q) is a brief
assessment designed for use in diverse settings to a) identify those in
need of a longer, more detailed assessment; b) identify those who may
benefit from a brief intervention; and c) guide staff to make effective
referral and placement decisions. Scales include those for general life
problems (general risk factors, sources of stress, health distress), internal
behavior (depression, suicide risk, anxiety), external behavior (activity
and inattention, conduct disorder/aggression, illegal activities), and
substance-related difficulties (substance use and abuse, substance
dependence). The GAIN-Q scales were developed using data from two
large treatment outcome studies, one involving adolescents (Cannabis
Youth Treatment or CYT, N=600, 82% boys, 48% meeting criteria for
dependence and 50% for abuse, most with multiple emotional or
behavioral problems) and the other on adults (Early Re-Intervention or
ERI, N=448, 59% female, 94% lifetime dependence). Subsets of items
from the longer GAIN-I (Dennis, 2002) were selected for the shorter
GAIN-Q through the application of classical and summative measurement
theories. Coefficient alpha on the total score is .91 for adolescents and
.94 for adults, with scale and subscale alphas in the moderate to high
range. Evaluation of the summative scales’ reliability and utility is
achieved by the indices’ relationships with a number of logically related
variables. The GAIN-Q is in use by over 20 research and clinical sites
across the United States, allowing for further analysis of the instrument’s
psychometric properties and the creation of norms.
In this presentation,
we aim to…
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Introduce the GAIN-Q instrument and its
scales and subscales.
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Explain the development of the instrument
using adolescent and adult samples.
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Present initial evidence of validation for the
instrument using adolescent and adult
samples.
The GAIN-Q is part of the
GAIN Family of Instruments
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GAIN-I – Comprehensive biopsychosocial intake
assessment for diagnosis and placement of
individuals coming into substance abuse treatment
(Dennis et al., 2002)
GAIN-M90 – 90 day follow-up version of the GAIN-I
GAIN-CI – Intake assessment for collaterals (e.g.,
family, friends) of individuals going into treatment
GAIN-CM – 90 day follow-up version of the GAIN-CI
GAIN-Q – Brief assessment used to identify various
life problems among adolescents and adults in the
general population; designed for use by personnel in
diverse settings (e.g., EAP, SAP, health clinics, JJ,
CJ); created from a subset of items on the GAIN-I
How is the GAIN-Q used?
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Identify those in need of a longer, more
detailed assessment
Identify those who may benefit from a
brief intervention
Guide staff to make effective referral and
placement decisions
Although it does not provide diagnostic
information per se, it does identify areas
in need of further exploration.
Features of the GAIN-Q
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Arranged in 10 sections (Background, General Factors,
Sources of Stress, Physical Health, Emotional Health,
Behavioral Health, Substance-Related Issues, Service
Utilization, End, Case Disposition)
Ten pages in length
Hard copy assessment or computer administration
Interviewer- or self-administered in 20-30 minutes
Most items written in a “yes/no” format
Scoring profiles and narrative reports to facilitate
interpretation
Can be combined with other information to produce
Personal Feedback Reports and other interventionspecific reports.
Development of the GAIN-Q
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Data from adolescent and adult samples were used.
Scales were created on assumptions of classical and
summative measurement models.
Classical measurement model includes internally
consistent indicators that are combined to estimate an
underlying latent trait; predictive variance is manifest
in the common variance of indicators.
Summative model assumes scores are linear
combinations of variety of behaviors which define the
domain and are evaluated on whether they exhibit
relationships with logically related variables; predictive
variance is manifest in the total variance.
Development Sample
Characteristics
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Adolescent sample (N=600) was predominantly
male (83%), Caucasian (62%), ages 15-16
(55%), had one or more emotional or
behavioral problems (95%), used marijuana
weekly (71%), & met criteria for abuse (50%;
48% dependence).
Adult sample (N=448) was predominantly
female (59%), African-American (79%), 21+
years, & met criteria for lifetime dependence at
intake (94%).
General Life Problems Index
(a measure of general risk factors associated with
substance use and mental health problems)
 Subscales are General Factors, Sources of
Stress, & Health Distress Index.
 Items were drawn from multiple sources,
including the National Household Survey of
Drug Abuse (NHSDA), National Health
Interview Survey (NHIS), Illinois Youth Survey
(IYS), and DSM-4.
 Items are empirically associated with drug
abuse and mental health problems.
Internal Behavior Index
(a measure of past year signs & symptoms
of depression & anxiety)
Subscales are Depression Symptom Index,
Suicide Risk Index, & Anxiety Symptom
Index.
Adoles.
Adults
Scale/Sub-scale Name
Alpha
Alpha
.86
.90
 Depression Symptom Index
.73
.84
 Suicide Risk Index
.54
.75
 Anxiety Symptom Index
.82
.88
Internal Behavior Index
External Behavior Index
(a measure of past year signs & symptoms of
activity & inattention, conduct disorder,
& criminal behavior)
Subscales are Activity-Inattention Index,
Conduct Disorder-Aggression Index, &
General Crime Index.
Adoles.
Adults
Scale/Subscale Name
External Behavior Index
Alpha
.83
Alpha
.88
 Activity-Inattention Index
.77
.88
 Conduct Disorder-Aggression Index
.74
.78
 General Crime Index
.71
.69
Substance Problem Index
(a measure of problems associated with use, abuse,
& dependence on drugs & alcohol)
Subscales are Substance Use and Abuse
Index & Substance Dependence Index.
Adoles.
Alpha
.82
Adults
Alpha
.82
 Substance Use and Abuse Index
.63
.67
 Substance Dependence Index
.75
.79
Scale/Subscale Name
Substance Problem Index
Validation Analyses
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Examine the level and pattern of co-occurring
disorders (Internal, External, Neither, Both -- as
defined by GAIN-I clinical scales’ items) using
the abbreviated set of GAIN-Q clinical scales’
items.
Using GAIN-Q data, predict membership in
each of the four co-occurring disorders groups
(as defined by the GAIN-I data).
Adolescents
Internal Distress
External Behaviors
Substance Problems
100%
75%
50%
25%
Neither (n=202)
Internal Only (n=31)
SDI-7
SUAI-9
SPI
GCI-4
CDAI-5
AII-6
EBI
ASI-7
SRI-5
DSI-5
IBI
0%
External Only (n=194)
Both (n=168)
Adults
Internal Distress
External Behaviors
Substance Problems
100%
75%
50%
25%
SDI-7
SUAI-9
SPI
GCI-4
CDAI-5
AII-6
EBI
ASI-7
SRI-5
DSI-5
IBI
0%
Neither (n=103)
External Only (n=10)
Internal Only (n=141)
Both (n=193)
Evidence for
Predictive Validity
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Adult group – 83% of cases were correctly
classified; Cohen’s kappa between original
group membership and predicted group
membership was .75 (p<.001; st. error =
.027, N=425)
Adolescent group – 75% of cases were
correctly classified; Cohen’s kappa between
original group membership and predicted
group membership was .64 (p<.001; st. error
= .026; N=588)
Conclusions
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The GAIN-Q is a short assessment currently used to
identify those in need of more indepth evaluation or
those who may benefit from a brief intervention.
Analyses of the GAIN-Q’s classical scales and
subscales reveal moderate to high internal
consistency; summative scales show strong
associations with logically related variables.
Evidence for predictive validity includes strong
associations between GAIN-I categories of cooccurring disorders and shorter GAIN-Q scale scores;
classification analyses significantly predicted
membership in co-occurring disorder groups.
Next Steps for the GAIN-Q
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Collect and analyze data across a wide variety of
factors (i.e., setting, placement, developmental
level, culture, gender, race, etc.) to create
meaningful norms.
Translate the GAIN-Q into the 2nd and 3rd most
widely used languages in the United States: Spanish
and American Sign Language.
Continue with the further development of the GAINQ and its resources in response to user need and
input. (The GAIN-Q is currently in use in
approximately 20 research and clinical sites around
the country, including recently introduced profiles,
narrative reports, and intervention-specific reports.)
Further Information
& Acknowledgement
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For further information, contact Dr. Janet C. Titus,
Chestnut Health Systems, 720 W. Chestnut St.,
Bloomington, IL 61701 [email protected]. GAIN-Q
materials are available at www.chestnut.org/
LI/GAIN/GAIN-Q. This poster is at www.chestnut.
org/LI/Posters.
The initial development of the GAIN-Q and its manual
was supported by the Center for Substance Abuse
Treatment (grant no. TI 11320, contract no. 217-006504, contract no. 270-97-7011), the National Institute
on Alcohol Abuse and Alcoholism (grant no. R01
AA10368), the National Institute on Drug Abuse (grant
no. R01 DA 11323), and the Macon County Office of
Probation in Decatur, IL.