WHO ASSIST Working Group member: Robert Ali for Drug and Alcohol Addiction Services Council, Adelaide, Australia

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The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility

Although participants with psychiatric symptoms, specific risk factors, or rare demographic characteristics can be difficult to identify and recruit for participation in research, participants with...

http://journals.sagepub.com/doi/pdf/10.1177/2167702612469015

Using Mechanical Turk to Study Clinical Populations

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive and integrated approach to the delivery of early intervention and treatment services through universal screening for persons with substance use disorders and those at risk. This paper describes research on the components of SBIRT conducted during the past 25 years, including the development of screening tests, clinical trials of brief interventions and implementation research. Beginning in the 1980s, concerted efforts were made in the US and at the World Health Organization to provide an evidence base for alcohol screening and brief intervention in primary health care settings. With the development of reliable and accurate screening tests for alcohol, more than a hundred clinical trials were conducted to evaluate the efficacy and cost effectiveness of alcohol screening and brief intervention in primary care, emergency departments and trauma centers. With the accumulation of positive evidence, implementation research on alcohol SBI was begun in the 1990s, followed by trials of similar methods for other substances (e.g., illicit drugs, tobacco, prescription drugs) and by national demonstration programs in the US and other countries. The results of these efforts demonstrate the cumulative benefit of translational research on health care delivery systems and substance abuse policy. That SBIRT yields short-term improvements in individuals' health is irrefutable; long-term effects on population health have not yet been demonstrated, but simulation models suggest that the benefits could be substantial.

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Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a Public Health Approach to the Management of Substance Abuse.

Aim The concurrent, construct and discriminative validity of the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study.

Participants  One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments.

Measurements  Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsley Addiction Profile (MAP).

Findings  Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76–0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78); and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48–0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50–96%) and sensitivities (54–97%) for most substances.

Conclusions  The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use.

Validation of the alcohol, smoking and substance involvement screening test (ASSIST)

Psychometric properties of the 11-item self-report Drug Use Disorders Identification Test (DUDIT) were evaluated in a sample of heavy drug users from prison, probation, and inpatient detoxification se

Evaluation of the Drug Use Disorders Identification Test (DUDIT) in Criminal Justice and Detoxification Settings and in a Swedish Population Sample

The US Preventive Services Task Force recommended that physicians use the CAGE questions to screen patients for alcohol abuse. A similarly brief screening instrument for abuse of other drugs is needed. Two conjoint screening questionnaires for alcohol and other drug abuse were adapted from the CAGE questions and the Short Michigan Alcoholism Screening Test (SMAST). For 124 patients of an academic, community family practice, the conjoint questionnaires and their forerunners were compared with DSM-III-R diagnoses of substance use disorders as measured by the Diagnostic Interview Schedule-Revised (DIS-R). The SMAST and its conjoint analog exhibited low sensitivity. The CAGE Adapted to Include Drugs (CAGE-AID) was more sensitive but less specific for substance abuse than the CAGE, especially when a reduced criterion score was employed. The CAGE-AID was more sensitive than the CAGE for subjects of varying sex, income, and level of education, as well as most patterns of substance use disorders. The diminished specificity of the CAGE-AID may have been, at least in part, artifactual. The CAGE-AID holds promise for identifying primary care patients with alcohol and drug disorders.

R L Brown

Papers

Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice.