By Colin Bradbury

• Analysis suggests that clients’ CISS scores (indicating severity of substance misuse problem) reduce in line with progression through treatment.
• Alcohol consumption also reduces along with the continuum of number of sessions received and in line with the reduction in CISS scores.
• Clients who have their case closed (apart from those receiving basic harm minimisation messages or being discharged due to lack of progress) on average score below the CISS cut off point for "positive treatment outcome."
• Conversely, individuals who are referred on to external services had a higher mean CISS score, thus indicating an appropriate use of treatment resource.

The Christo Inventory for Substance-misuse Services (CISS) is a standardised* outcome tool that ADS has adopted across all its services to measure the impact of treatment and outcome. This report summarises the data collected by ADS staff on client CISS scores at assessment and then every fourth session thereafter. The scores are taken from practically every office across the Greater Manchester Probation Service (GMPS). The data is not presented broken down by each individual district or separate contract, but is instead shown as a whole. This is because this type of quantitative analysis requires as many cases as possible are pooled together in order to maximise validity.

In the 6 month period concerned, Alcohol and Drug Services (ADS) staff completed 630 CISS questionnaires on a total of 503 individuals. Table 1 shows the breakdown of offices from which these data are drawn.

Table 2 shows the proportion of males to females in the sample. The figures are roughly commensurate with the proportion of males to females serving a probation order. Table 3 gives a breakdown of the ethnic origin of the people on which the CISS questionnaires were completed.

Figure 1 demonstrates that, despite differences in proportions, gender and ethnic groups scored very similarly to each other. Males and female averages were 0.2 of one point different. For the purposes of comparability, the sample was also crudely spilt between "white" and "other" ethnic origin and, again, there were no significant differences (0.8 of one point). Age was also examined and was found not be an influence on scores. All this should be expected of a standardised instrument such as the CISS, but it useful to confirm this.

The graph contained within Figure 2 gives an indication of the relationship between the number of sessions received and a reduction in average scores on the CISS. It should be noted that there is much more data for sessions 1 and 4 than there are for the remaining four milestones. This will always be the case to some extent, as ADS aims to deliver brief task focussed work with individuals. However, as more data is collected, this will allow the hypotheses of a correlation between the number of sessions received and reduction in problem severity to be asserted more confidently.

Figure 3 deals exclusively with clients that were assessed as having alcohol as a primary problem drug. The red bars indicate the overall reduction in CISS sources for the alcohol users over the sessions. The blue bars show a corresponding reduction in reported alcohol consumption in the 7 days leading up to the session (NB for the purposes of comparison, mean unit consumption has been divided by 10). This graph therefore demonstrates that mean alcohol consumption also goes down in line with the number of sessions attended.

When examining individuals who had their cases closed, it appears ADS staff have been generally ending treatment input at appropriate stages (see Figure 4). The literature on the CISS indicates that that a final score of below six indicates a positive treatment outcome. All the people that had their cases closed (with the exception of individuals who had their contact ended having received harm minimisation input or closure on the grounds of no progress) averaged a score below 6. The bar at the end of the graph gives a comparison score for people whose treatment was on-going. Again, with the same two exceptions, all case closures tended to be markedly below the average CISS score for those receiving on-going treatment.

In contrast, where it was necessary to refer individuals on to other services (for example to receive medical interventions or go into rehab) then the trend is reversed. Figure 5 demonstrates that individuals with a generally high CISS score are being referred on, thus suggesting an appropriate use of resource.

The CISS has proved to be a useful and flexible tool for measuring outcomes across a range of dimensions. This preliminary analysis, to be supplemented with further data at a later date, shows encouraging trends in terms of average score reductions and suggests that cases are closed and individuals referred on at generally appropriate stages.

• Colin Bradbury is research, outcome monitoring and evaluation manager with ADS, 87 Oldham Street, Manchester M4 1LW (tel: 0161-214 6409, email: colin.bradbury@alcoholanddrugservices.org.uk ).

 Links within CISS site 

CISS home page and index.

CISS form

CISS general overview. Unedited version of an explanatory article about CISS which appeared in Addiction Today Magazine (Nov/Dec, 1999)

CISS comparison scores for harm minimisation oriented methadone prescribing outpatient services

CISS comparison scores for an outpatient alcohol service (item score comparisons with drug users)  

CISS comparison scores and cutoffs for abstinence oriented services

CISS technical information (reliability, validity, correlations with other scales)  

CISS detailed information. Validation of the Christo Inventory for Substance-misuse Services (CISS): a simple outcome evaluation tool (from Drug and Alcohol Dependence, 2000).

ã 1998 George Christo PhD, PsychD.