The Global Appraisal of Individual Needs (GAIN)¹ is a 1–2 hour standardized biopsychosocial that integrates clinical and research assessment for people presenting to substance abuse treatment. The GAIN – Short Screener (GSS) is 3–5 minute screener to quickly identify those who would have a disorder based on the full 60–120 minute GAIN and triage the problem and kind of intervention they are likely to need along four dimensions (internalizing disorders, externalizing disorders, substance disorders, and crime/ violence). Data were collected from 6,177 adolescents and 1,805 adults as part of 77 studies in three dozen locations around the United States that used the GAIN. For both adolescents and adults the 20‐item total disorder screener (TDScr) and its four 5‐item sub‐screeners (internalizing disorders, externalizing disorders, substance disorders, and crime/violence) has good internal consistency (alpha of .96 on total screener), is highly correlated (r—.84 to .94) with the 123‐item longer scales in the full GAIN. The GSS also does well in terms of its receiver operator characteristics (90% or more under the curve in all analyses) and has clinical decision‐making cut points with excellent sensitivity (90% or more) for identifying people with a disorder and excellent specificity (92% or more) for correctly ruling out people who did not have a disorder. The GSS has good potential as an efficient screener for identifying people with co‐occurring disorders across multiple systems and routing them to the right services and more detailed assessments.

This article reviews progress in adapting addiction treatment to respond more fully to the chronic nature of most patients' problems. After reviewing evidence that the natural history of addiction involves recurrent cycles of relapse and recovery, we discuss emerging approaches to recovery management, including techniques for improving the continuity of care, monitoring during periods of abstinence, and early reintervention; recent developments in the field related to self-management, mutual aid, and other recovery supports; and system-level interventions. We also address the importance of adjusting treatment funding and organizational structures to better meet the needs of individuals with a chronic disease.

Using data from 1,162 people entering treatment and followed up (> 94%) for 8 years, this article examines the relationship between the duration of abstinence (1 month to 5 or more years) and other aspects of recovery (e.g., health, mental health, coping responses, legal involvement, vocational involvement, housing, peers, social and spiritual support), including the trend and at what point changes occur. It also examines how the duration of abstinence at a given point is related to the odds of sustaining abstinence in the subsequent year. The findings demonstrate the rich patterns of change associated with the course of long-term recovery.